Needle aspiration cytology of metastatic high-grade transitional-cell carcinomas of the urinary tract

Abstract

We reviewed 4 cases of high‐grade transitional‐cell carcinoma (TCC) of the urinary tract with solitary pulmonary metastases that were studied by transthoracic needle aspiration biopsy cytology. There were two grade II and two grade III TCCs. The two grade II tumors yielded, in needle aspirates, syncytial tumor‐cell clusters showing ill‐defined, granular cytoplasm and slightly pleomorphic nuclei with inconspicuous nucleoli. In one case the tumor‐cell clusters showed a focal acinar arrangement, mimicking cells of an adenocarcinoma. In both cases the electron microscopy (EM) study of aspirated tumor cells revealed epithelial cells with well‐formed cell junctions, intracytoplasmic vesicles, apical short microvilli, and focal interdigitation of lateral cell membranes, suggesting a urothelial neoplasm. The two grade III TCCs yielded, in needle aspirates, pleomorphic malignant cells singly and in small clusters, showing well‐defined, granular cytoplasm and pleomorphic nuclei containing prominent nucleoli, suggesting a poorly differentiated adenocarcinoma or an anaplastic large‐cell carcinoma. By EM examination the aspirated tumor cells from one case revealed well‐formed cell junctions, intracytoplasmic vesicles, poorly formed microvilli, and focal interdigitation of lateral cell membranes, suggesting a urothelial differentiation. In the other case the tumor cells were pleomorphic cells with occasional cell junctions and no ultrastructural features as seen in the other 3 cases of TCC. The tumor cells from the two grade II TCCs showed strong immunopositive reaction with keratin 7 antibody and weakly positive reaction with carcinoembryonic antigen antibody (CEAA), while those of the two grade III TCCs displayed only a weak and focal immunopositive staining with keratin 7 antibody and strong reaction with CEAA. Diagn. Cytopathol. 1998;18:409–415. © 1998 Wiley‐Liss, Inc.

Revisiting cercariform cells: Small cell carcinoma masquerading as cercariform cells

“…Urothelial carcinoma is one of the most common malignancies that manifests as a solitary mass when it metastasizes . This poses a diagnostic challenge in long time smokers with history of UC who present with a solitary lung mass, because a new lung primary carcinoma is a possibility, as illustrated in the case we described.…”

Cercariform cells

“…We observed that, independent of the grade of the primary tumors, the smears showed numerous cercarifom cells with varied morphology, as described by Renshaw and Madge. 5 Thus, the paper of Ho et al 1 is amazing because the authors say not to observe cercariform cells, but they illustrated some of these in their Figure 1A. They report four cases of pulmonary metastatic high-grade TCC evaluated by FNAB.…”

“…I read with great interest the paper of Ho et al 1 about metastatic high-grade transitional-cell carcinomas.…”

“…In our experience, cercariform cells (or cells with cytoplasmic processes and tails) are a good marker for urothelial lineage, and we recommend that Ho et al 1 review their slides in order to look for cercariform cells between the background and cell clusters in their smears.…”

Cercariform cells

“…2 Those tumors consisted of two grade II and two grade III TCCs. In each case, 4-6 direct smears were prepared from the FNA, and they were stained by the Papanicolaou method.…”