Urine Cytology

Normal urothelial cells in voided urine are large and have a round, homogeneous, small nucleus [fig normal urine cytology]. Depending on the differentiation of the bladder cancer, the ratio between nucleus and cytoplasm shifts in favour of the nucleus [fig pathological urine cytology]. The nucleus becomes irregular in shape and staining with increasing dedifferentiation [Tab. criteria for malignancy of urothelial cells].

**Tab.: urine cytology criteria for malignancy (Rathert und Roth, 2008):** urothelial cells of different layers have different nucleus size and nucleus-cytoplasm ratio. Basal cells are smaller than intermediate cells, surface cells are the largest urothelial cells.
• Increasing size of the nucleus in relation to the cytoplasm
• unregular nucleus shape
• multiple and unregular nucleoles
• thick and unregular nuclear envelope
• Hyperchromasia: increased staining of the nucleus
• granular (or stippled) chromatine

The microscopic examination of exfoliated urothelial cells in voided urine can reliably identify G2 and G3 cells of urothelial carcinoma. Well-differentiated tumors are more difficult to identify, since fewer cells are shed and the differences between inflammation and well-differentiated tumors are not unequivocal.

Normal urothelial cells are large (see leukocytes) and have a small round nucleus.

figure: urine cytology with high grade tumor cell

Urine cytology with a high grade tumor cell: in comparison to the normal urine cytology, a reduction of the cytoplasm and an enlargement of the nucleus is seen. The nucleus is not round and of inhomogen staining.

24-h urine

Index

Semen analysis

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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References

Rathert, P. & Roth, S.: Urinzytologie: Praxis und Atlas
Springer Verlag, Berlin, 2008

Deutsche Version: Urinzytologie

Last update

Dr. med. Dirk Manski
man...@urologielehrbuch.de