High‐grade urothelial carcinoma in urine cytology with jet black and smooth or glassy chromatin

Abstract

BACKGROUND: Some high-grade urothelial carcinomas (UCs) in urine cytology can have jet black, smooth, or glassy chromatin, but to the authors' knowledge, the incidence and criteria for diagnosis are not well described. The current study was performed to define the incidence and appearance of high-grade UC in urine cytology in cytospin preparations with jet black and smooth or glassy chromatin. METHODS: Cytospin preparations from 331 cases with biopsy follow-up (230 benign/low-grade UCs and 101 malignant UCs) were reviewed. RESULTS: Cases with malignant cells with jet black and smooth or glassy chromatin were identified in a total of 60 cases (59.4% of all malignancies). These comprised 18 carcinoma in situ cases, 28 high-grade papillary UCs, 8 invasive UCs, 3 squamous cell carcinomas, 2 adenocarcinomas, and 1 melanoma. Of the 93 high-grade UCs, 51 (54.8%) had cells with either jet black and smooth or glassy chromatin. These cells were the only type of malignant cell in 6 of 101 cases (5.9%). All cases had at least 50 cells with jet black nuclei.Nuclei with jet black and smooth chromatin often were smaller than normal urothelial cells, often but not always elongate, had irregular nuclear outlines including pointed areas, and usually were accompanied by necrosis. Cells with glassy chromatin often were larger than normal urothelial cells, had rounder but still irregular nuclei, and also had frequent necrosis.CONCLUSIONS: Malignant urothelial cells in urine cytology with jet black chromatin are common and can be diagnosed as "positive for malignancy" based on their irregular nuclear outline, increased cellularity ( 50 abnormal cells), and frequent necrosis.

Hypochromatic large urothelial cells in urine cytology are indicative of high grade urothelial carcinoma

“…Moreover we suggest that the absence of hyperchromasia could not preclude a diagnosis of HGUC, in cells having a very large nucleus, nuclear to cytoplasm ratio (N/C) >0.7, irregular nuclear membranes, coarse chromatin and macronucleoli. It has been seen that urothelial high grade carcinoma has multiple different cytological patterns and when strictly applying a single set of diagnostic criteria, some cases will be overlooked .…”

Unusual BK polyomavirus‐associated urologic malignancies in renal transplant recipients: Report of two cases and review of the literature

“…However, decoy cells and malignant urothelial cells can co‐exist as shown in cases described in Table . Occasionally, HGUC cells can have features like jet black and smooth or glassy chromatin similar to decoy cells . Often a difficult task, the distinction could be made based on the cellularity and the nuclear membrane irregularity .…”

“…16,21,24 Occasionally, HGUC cells can have features like jet black and smooth or glassy chromatin similar to decoy cells. 45 Often a difficult task, the distinction could be made based on the cellularity and the nuclear membrane irregularity. 45 Table 2 summarizes the cytologic features helpful in the differential diagnosis between degenerated urothelial cells, decoy cells and malignant urothelial cells.…”

“…45 Often a difficult task, the distinction could be made based on the cellularity and the nuclear membrane irregularity. 45 Table 2 summarizes the cytologic features helpful in the differential diagnosis between degenerated urothelial cells, decoy cells and malignant urothelial cells. 46 In a study of BKV-associated urothelial carcinoma available only in abstract form, urine cytology showed a small cell ("HSIL-like") pattern in three of four cases, while the remaining case showed a pleomorphic pattern.…”

Mankind and the machine: A relationship of symbiosis or conflict?

“…It is likely that the machines will use similar criteria. From our experience and that of others, humans can make the diagnosis in absence of these criteria. For example, although the N/C ratio and nuclear hyperchromasia are very important features used (by humans) to make a diagnosis of urothelial carcinoma, our morphometric analysis of cases has shown that a small percentage of these cases have hypochromatic nuclei or lower nucleocytoplasmic ratios.…”