Background
The Paris System (TPS) introduced diagnostic criteria for urine cytology to improve reproducibility among pathologists. Thus far, most cytology studies have investigated application of TPS on lower urinary tract specimens. Also, it is unclear which cytologic features are most predictive of malignancy, particularly in the upper urinary tract. We evaluate concordance rates of preoperative upper urinary tract cytology specimens before and after application of TPS criteria with surgical resections and assess cytologic features associated with malignancy.
Design
54 resections with high‐ and low‐grade urothelial carcinoma (HGUC, LGUC) from 2000‐2016 with available preoperative cytology (n = 61) were identified. Cytology was re‐reviewed to evaluate cytologic features and provide diagnoses before and after TPS implementation.
Results
The most common cytologic features associated with HGUC were N:C ratios ≥0.7 (88%), hyperchromasia (83%), coarse chromatin distribution (67%), and nuclear pleomorphism in cell clusters (65%). Application of TPS criteria resulted in 10 diagnostic downgrades and 6 diagnostic upgrades. After TPS criteria were applied, the sensitivity of a positive diagnosis decreased from 29% to 19%. The morphologic feature most consistently associated with a downgrade from positive to suspicious was a lack of marked nuclear contour irregularities in atypical urothelial cells.
Conclusion
Using strict TPS criteria in upper urinary tract cytology specimens may decrease the frequency of positive diagnoses with a concurrent increase in suspicious diagnoses. These findings may indicate that different morphologic features, particularly markedly irregular nuclear contours, may have different predictive values for HGUC in upper urinary tract cytology specimens compared with those from the lower urinary tract.
Clinical utility and concordance of upper urinary tract cytology and biopsy in predicting Clinicopathologic features of upper urinary tract urothelial carcinoma. Human Pathology.
Background
Rapid (“warm”) autopsies of patients with advanced metastatic cancer provide important insight into the natural history, pathobiology and histomorphology of disease in treatment-resistant tumors. Plasmacytoid urothelial carcinoma (PUC) is a rare variant of urothelial carcinoma characterized by neoplastic cells morphologically resembling plasma cells. PUC is typically aggressive, high-stage at presentation, and associated with poor outcomes. Recurrence is common in PUC, with the majority of recurrences occurring in the peritoneum.
Case presentation
Here, we report rapid autopsy findings from a patient with recurrent PUC. The patient had persistent pain after cystoprostatectomy, although initial post-operative imaging showed no evidence of disease. Imaging obtained shortly before his death showed only subtle growth along vascular tissue planes; however, extensive disease was seen on autopsy. Plasmacytoid tumor cells formed sheets involving many serosal surfaces. Molecular interrogation confirmed a mutation in CDH1 exon 12 leading to early truncation of the CDH1 protein in the tumor cells.
Conclusions
The sheet-like growth pattern of PUC makes early phases of disease spread much more difficult to capture on cross-sectional imaging. Alternative forms of surveillance may be required for detection of recurrent PUC, and providers may need to treat based on symptoms and clinical suspicion.
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