Koss's Cytology of the Urinary Tract with Histopathologic Correlations

Fifteen years have elapsed since the publication of the original book under the same title.  With the passage of time little has changed and the same conceptual mistakes continue to be made in the practice of urinary cytopathology as in the past.&nbs

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The Cytologic Makeup of the Urinary Sediment According to the Collection Technique

Keywords Collection techniques • Makeup of voided urine • Cell clusters in voided urine • Pseudoclusters • Cell preservation in voided urine • Squamous cells • Superficial umbrella cells • Urothelial cells from deeper layers • Instrumentation • Intestinal metaplasia • Ancillary tests • Catheterized urine • Flexible cystoscopy • Bladder washings • Cytologic makeup of retrograde catheterization urine • Cytologic makeup of brushings • Cytologic makeup of ileal conduit urine • Advantages and disadvantages of various collection methods

Introduction The collection techniques used to obtain urinary specimens include voided and catheterized urine, bladder, ureteric and renal pelvic washings and brushings, retrograde catheterization of ureters, renal pelves, and ileal conduit (described in detail in Chap. 2). These collection techniques, particularly instrumentation, have a significant effect on the makeup of the urinary sediment. Catheterization of the bladder, retrograde catheterization of the ureter and renal pelves and brushings, virtually always, result in removal of urothelial cell clusters that may be mistaken for fragments of urothelial papillary tumors. Thus, a thorough knowledge of the cytologic features observed in the various collection techniques is very important in diagnostic interpretation. Tables 4.1 and 4.2 indicate the advantages and disadvantages and the cytologic appearance of urothelial cells in various specimen-collection methods.

Cytologic Makeup of the Sediment of Normal Voided Urine Spontaneously voided urine from normal patients contains relatively few urothelial cells (Fig. 4.1a). These cells may occur singly or may desquamate in clusters. Smaller cells from the deeper layers of the epithelium are readily distinguished from the much larger umbrella cells. In voided urine, the nuclei of the small urothelial cells have a well-preserved nuclear membrane, are spherical in configuration, stain with variable intensity, and may contain visible nucleoli (Fig. 4.1b–d). The cytoplasm is scanty, often frayed at the border, and faintly basophilic. Multinucleated umbrella cells are rare in spontaneously voided urine, except after diagnostic and therapeutic procedures. Intermediate-size umbrella cells and cell clusters may be observed (Fig. 4.2a, b). Clusters of urothelial cells may be observed in 20% of voided urine in the absence of disease. It should be noted that liquid-based processing techniques may artificially cause both clustering of cells (pseudoclusters) and disruption of large true fragments. Millipore filter processing better preserves L.G. Koss and R.S. Hoda, Koss’s Cytology of the Urinary Tract with Histopathologic Correlations, DOI 10.1007/978-1-4614-2056-9_4, © Leopold G. Koss 2012

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The Cytologic Makeup of the Urinary Sediment According to the Collection Technique

Table 4.1 Principle advantages and disadvantages of various cytologic methods of investigation of lower urinary tract Method Advantage