Fig. 1The voided urine cytology of micropapillary variant of urothelial carcinoma. (A) The tumor displays high cellularity and an inflammatory background, with many small and tight papillary cellular clusters. Small acinar structure is present (inset). (B) With small and tight papillary clusters, small numbers of single tumor cells are scattered. (C, D) The nuclear cytoplasmic ratio is moderate to high. The cytoplasm is dense or shows vacuolization. The nucleus exhibits irregular nuclear membranes, hyperchromatic and granular chromatin patterns with small nucleoli.
Fig. 2The voided urine cytology of high-grade urothelial carcinoma. (A) The tumor shows high cellularity, necrotic background with many scattered single cells. (B) The tumor cells show large loose papillary cellular clusters and scattered single cells in the inflammatory background. (C) Many scattered single tumor cells are present without cellular grouping. (D) The nuclear cytoplasmic ratio is moderate. The cytoplasm is dense or shows vacuolization. The nucleus exhibits irregular nuclear membranes, somewhat vesicular and granular chromatin patterns with small nucleoli.
Table 1.The clinical features of micropapillary urothelial carcinoma (MPUC) and high-grade urothelial carcinoma (HGUC)
Case No. |
Age (yr) |
T stage |
Treatment |
Recur/Metastasis |
Outcome (follow-up, mo) |
MPUC |
|
|
|
|
|
1 |
79 |
T2 |
TURB + CTx |
Presence/absence |
Alive with disease (6) |
2 |
76 |
T2 |
TURB + CTx |
Presence/bone |
Death of disease (72) |
3 |
75 |
T1 |
TURB + BCG |
Absence/absence |
Alive without disease (24) |
4 |
78 |
T1→T2 |
TURB + BCG |
Presence/mesentery |
Alive with disease (12) |
5 |
82 |
T1 |
TURB + BCG |
Absence/absence |
Alive without disease (14) |
6 |
78 |
T1→T2 |
TURB + BCG |
Presence/absence |
Alive with disease (12) |
HGUC |
|
|
|
|
|
1 |
81 |
T1 |
TURB + BCG |
Absence/absence |
Alive without disease (7) |
2 |
71 |
T0→T1 |
TURB + BCG |
Presence/absence |
Alive with disease (8) |
3 |
43 |
T2 |
TURB + CTx + RTx |
Absence/lung, liver |
Alive with disease (14) |
4 |
62 |
T1 |
TURB + BCG |
Presence/absence |
Alive with disease (24) |
5 |
63 |
T1→T2 |
Cystectomy |
Presence/absence |
Alive with disease (10) |
6 |
66 |
T1 |
TURB + BCG |
Absence/absence |
Alive without disease (18) |
7 |
78 |
T1 |
TURB + BCG |
Absence/absence |
Alive without disease (24) |
Table 2.The cytologic features of micropapillary urothelial carcinoma (MPUC) and high-grade urothelial carcinoma (HGUC)
Case No. |
Cellularity |
Background |
No. of small cellular clusters/slidea
|
Small acinara
|
Degree of scattered single cellsa
|
Cytoplasm features |
N/C ratio |
Cellular pleomorphism |
Nuclear membrane irregularity |
Hyperchromasiaa
|
Chromatin pattern |
Nucleoli |
MPUC |
|
|
|
|
|
|
|
|
|
|
|
|
1-1 |
High |
Inflammatory |
16 |
Presence |
2+ |
Dense/vacuolated |
High |
Moderate |
Irregular |
Severe |
Coarse |
Small |
1-2 |
High |
Inflammatory |
13 |
Absence |
3+ |
Dense/vacuolated |
Moderate |
Moderate |
Irregular |
Moderate |
Coarse |
Small |
2 |
High |
Inflammatory |
150 |
Presence |
2+ |
Dense |
High |
Mild |
Irregular |
Severe |
Coarse |
Small |
3 |
Moderate |
Inflammatory |
36 |
Presence |
1+ |
Dense/vacuolated |
High |
Severe |
Irregular |
Severe |
Coarse |
Small |
4-1 |
High |
Inflammatory |
9.5 |
Presence |
2+ |
Dense |
Moderate |
Moderate |
Irregular |
Severe |
Coarse |
Small |
4-2 |
High |
Inflammatory |
10 |
Absence |
2+ |
Dense |
High |
Severe |
Irregular |
Moderate |
Coarse |
Small |
5 |
High |
Inflammatory |
10 |
Presence |
2+ |
Dense/vacuolated |
Moderate |
Moderate |
Irregular |
Severe |
Coarse |
Small |
6 |
High |
Inflammatory |
14 |
Absence |
1+ |
Dense/vacuolated |
Moderate |
Moderate |
Irregular |
Severe |
Coarse |
Small |
HGUC |
|
|
|
|
|
|
|
|
|
|
|
|
1 |
High |
Extensive necrotic |
5 |
Absence |
3+ |
Dense/vacuolated |
Moderate |
Moderate |
Irregular |
Moderate |
Coarse |
Small |
2-1 |
High |
Inflammatory |
3 |
Absence |
3+ |
Dense/vacuolated |
High |
Moderate |
Irregular |
Modearte |
Coarse |
Large |
2-2 |
High |
Inflammatory |
5 |
Absence |
2+ |
Dense/vacuolated |
Moderate |
Severe |
Irregular |
Moderate |
Coarse |
Large |
3 |
High |
Extensive necrotic |
7 |
Absence |
3+ |
Dense/vacuolated |
Moderate |
Moderate |
Irregular |
Moderate |
Coarse |
Small |
4 |
Moderate |
Inflammatory |
0 |
Absence |
3+ |
Dense |
High |
Moderate |
Irregular |
Moderate |
Coarse |
Small |
5 |
Moderate |
Inflammatory |
1 |
Absence |
3+ |
Dense |
High |
Moderate |
Irregular |
Severe |
Coarse |
Small |
6 |
Low |
Inflammatory |
0 |
Absence |
2+ |
Dense |
High |
Moderate |
Irregular |
Severe |
Coarse |
Small |
7 |
High |
Inflammatory |
12 |
Absence |
2+ |
Dense |
Moderate |
Severe |
Irregular |
Moderate |
Coarse |
Small |