Cyto-histo Correlations of Plasmacytoid and Micropapillary Variants of High-grade Urothelial Carcinoma: Do They Fit Well in The Paris System for Reporting Urinary Cytology?

Suo, Liye; Vega, Ivonne; Thrall, Michael J.

doi:10.1016/j.jasc.2020.07.035

Cited by 3 publications

(11 citation statements)

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“…That said, we found similar features such as enlarged hyperchromatic nuclei, occasional prominent to small nucleoli, and a predominance of single/dyshesive cells. However, the previously described tumor diathesis and necrotic background were not identified in our cases 14,17 . Although earlier articles published in 2009 described the presence of tumor cells with eccentrically located nuclei, on a review of their published images, some of the tumor cells had a nuclear to cytoplasmic (N/C) ratio of ≥0.7, which in the current TPS system, depending on the numbers of tumor cells, would have merited either an SHGUC or HGUC diagnosis 13,14 .…”

Section: Discussionmentioning

confidence: 59%

“…However, the previously described tumor diathesis and necrotic background were not identified in our cases. 14,17 Although earlier articles published in 2009 described the presence of tumor cells with eccentrically located nuclei, on a review of their published images, some of the tumor cells had a nuclear to cytoplasmic (N/C) ratio of ≥0.7, which in the current TPS system, depending on the numbers of tumor cells, would have merited either an SHGUC or HGUC diagnosis. 13,14 Our results show that TPS criteria for HGUC were met in a subset of urine cytology cases with cytologic features of P-CIS only because of the presence of concurrent HGUC.…”

Section: Discussionmentioning

confidence: 99%

“…The previously reported cytologic features of plasmacytoid urothelial carcinoma in urine cytology had corresponding biopsies showing invasive plasmacytoid urothelial carcinoma. [13][14][15][16][17] Although the focus of our study is the cytologic findings of the recently described P-CIS, one could argue that on cytology alone, it can be difficult to differentiate in situ carcinoma from invasive carcinoma. That said, we found similar features such as enlarged hyperchromatic nuclei, occasional prominent to small nucleoli, and a predominance of single/dyshesive cells.…”

Section: Discussionmentioning

confidence: 99%

“…In an image review of the prior publications, only 3 met the N/C ratio of ≥5. [15][16][17] Another concern with respect to the N/C ratio was addressed in the article by Suo et al 17 because some of the tumor cells that had irregular and hyperchromatic nuclei had an N/C ratio of <0.5. 17 An N/C ratio < 0.5 could pose a diagnostic pitfall for the TPS criteria because it does not meet the major criterion for the AUC category.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] Another concern with respect to the N/C ratio was addressed in the article by Suo et al 17 because some of the tumor cells that had irregular and hyperchromatic nuclei had an N/C ratio of <0.5. 17 An N/C ratio < 0.5 could pose a diagnostic pitfall for the TPS criteria because it does not meet the major criterion for the AUC category. The pattern described on histology as "architectural disorder" with cellular rounding was at best seen in only 1 of our cases.…”

Section: Discussionmentioning

confidence: 99%

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Urine cytology findings in patients with biopsy‐confirmed urothelial carcinoma in situ with plasmacytoid features

Nichols

Reynolds

McKenney

et al. 2021

Cancer Cytopathology

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BACKGROUND: Urine cytology is an important screening tool in the diagnosis of high-grade urothelial carcinoma.Diagnosis in urine samples follows criteria outlined by The Paris System for Reporting Urinary Cytology (TPS). However, cytologic characteristics of the recently described urothelial carcinoma in situ with plasmacytoid features (P-CIS) have not been described, and it is unknown whether they conform to TPS criteria for high-grade urothelial carcinoma. This study was aimed at better characterizing possibly unique cytologic features of P-CIS. METHODS: The authors collected urine cytology specimens from patients with subsequent bladder biopsy-proven P-CIS. Specimens were re-reviewed according to the TPS criteria. The proposed cytologic features of P-CIS (eccentric, enlarged, and hyperchromatic nuclei) were evaluated; this included the reproducibility of 3 cytopathologists for the proposed cytologic features. RESULTS:Seventy-four urine specimens from 18 patients with P-CIS-diagnosed bladder biopsies were identified. The TPS diagnoses of the 74 urine cytology specimens were as follows: negative for high-grade urothelial carcinoma (n = 26), atypical urothelial cells (n = 26), suspicious for high-grade urothelial carcinoma (n = 12), and high-grade urothelial carcinoma (n = 10). Only 7 urine specimens met the proposed cytologic criteria for P-CIS, and they had TPS diagnoses of negative for high-grade urothelial carcinoma (n = 1), atypical urothelial cells (n = 3), and high-grade urothelial carcinoma (n = 3). The κ interobserver agreement ranged from poor to fair. CONCLUSION: The features of P-CIS on urine cytology are subtle and infrequently reproducible and often do not meet the TPS criteria for diagnosis as high-grade urothelial carcinoma.In specimens that do not meet TPS criteria for high-grade urothelial carcinoma, P-CIS cytology in isolation would be best classified as atypical urothelial cells.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Urine cytology findings in patients with biopsy‐confirmed urothelial carcinoma in situ with plasmacytoid features

Nichols

Reynolds

McKenney

et al. 2021

Cancer Cytopathology

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Pleural fluid metastasis of plasmacytoid urothelial carcinoma in comparison to micropapillary and conventional high‐grade urothelial carcinoma: Cytologic and immuonohistochemical findings

Wang

Woodward

Menezes

et al. 2022

Diagnostic Cytopathology

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Plasmacytoid urothelial carcinoma (PUC) is a rare but clinically aggressive variant of high-grade urothelial carcinoma (HGUC). Cytological features include single plasmacytoid neoplastic cells with N:C ratio around 0.5, eccentric nuclei, nuclear hyperchromasia, irregular nuclear membrane, and vacuolated cytoplasm. Micropapillary urothelial carcinoma (MPUC) is another clinically aggressive variant of HGUC that shares some overlapping features of PUC. The diagnosis of these two aggressive variants in pleural effusions can be challenging due to features mimicking adenocarcinoma, unusual immunochemistry profile, and confusion with differential diagnoses, especially when pertinent clinical information is unavailable. We present report on one case each of pleural fluid metastasis of PUC and MPUC respectively, and com-

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Cytologic features of micropapillary variant urothelial carcinoma in urinary tract cytology: Case series and review of literature

Greenland

Peng

Vohra

et al. 2022

Diagnostic Cytopathology

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Background The micropapillary variant of urothelial carcinoma (MPVUC) is rare and aggressive. Surgical specimens often show atypical micro‐clusters (AMCs) of cells with hyperchromatic, pyknotic, peripheral, irregular nuclei with variable nuclear to cytoplasmic ratios. We reviewed urinary tract cytology (UTC) from patients with MPVUC and hypothesized that AMCs would be present similar to those in surgical specimens. Methods The archives were searched from 2000 to 2020 for patients with surgical cases with either MPVUC or conventional high‐grade urothelial carcinoma (HGUC) and with prior abnormal UTC. Two pathologists reviewed UTC cases and controls in a blinded manner for AMCs, with quantitation of none, low, moderate, and high. Interrater reliability was compared by quadratic weighted Cohen's Kappa test. The association between numerical average score and MPVUC status was determined by logistic regression. Results Five patients with invasive MPVUC, one patient with a noninvasive micropapillary component, and 15 control patients with conventional HGUC were included. All patients had prior or concurrent abnormal UTC samples. Increasing category of quantities of AMCs on cytology was associated with micropapillary status (OR 7.9, 95% CI 2.7–118, p = .045), with moderate agreement between raters (Cohen's Kappa 0.54, 95% CI 0.19–0.89, p = .004). Conclusions In patients with MPVUC on surgical specimen, AMCs were frequently observed on cytology. Similar atypical clusters were observed in patients with nonmicropapillary HGUC, albeit at lower frequency. However, given the WHO recommendation to diagnose micropapillary only if an invasive micropapillary component is present, a specific diagnosis of MPVUC on UTC cannot be based solely on the presence of AMCs.

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Cyto-histo Correlations of Plasmacytoid and Micropapillary Variants of High-grade Urothelial Carcinoma: Do They Fit Well in The Paris System for Reporting Urinary Cytology?

Cited by 3 publications

References 0 publications

Urine cytology findings in patients with biopsy‐confirmed urothelial carcinoma in situ with plasmacytoid features

Urine cytology findings in patients with biopsy‐confirmed urothelial carcinoma in situ with plasmacytoid features

Pleural fluid metastasis of plasmacytoid urothelial carcinoma in comparison to micropapillary and conventional high‐grade urothelial carcinoma: Cytologic and immuonohistochemical findings

Cytologic features of micropapillary variant urothelial carcinoma in urinary tract cytology: Case series and review of literature

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