tailieunhanh - Cytologic Detection of Urothelial Lesions - part 9

Tuy nhiên, các tế bào ung thư biểu mô tế bào thận nang có thể bắt chước các đại thực bào dự kiến trong một u nang thận lành tính. Nghiên cứu và immunochemistry Ploidy có thể rất hữu ích khi vật liệu đầy đủ là hút. | 150 5. Unusual Lesions reaching an accurate diagnosis. Fine needle aspiration is the preferred approach to lesions of the renal parenchyma. However cells from cystic renal cell carcinoma can mimic macrophages expected in a benign renal cyst. Ploidy studies and immunochemistry can be very helpful when sufficient material is aspirated. Metastases to the Urinary Tract Metastatic lesions to the urinary bladder and into ureters must be considered when history is consistent or when an unexpected cell population is found. Rectum uterus vagina and prostate are contiguous and may be sources of direct spread Figs. . Voided urines from women with occult gynecologic lesions may contain diagnostic cells in the urine Figs. . Therefore any woman presenting with hematuria should be catheterized to avoid vaginal contamination and to localize the source of bleeding. Drop metastases into the pouch of Douglas or onto the dome of the bladder occur from distant sites. A complete and accurate history obviously is necessary to include such lesions in the differential diagnosis Tables 8 and 9 . Table 8. Differential Diagnosis of Glandular Cells in Urine Normal glandular epithelium Cystitis Cystica Gynecologic -Menstrual endometrium -Endometriosis -Normal endocervical cells -Malignancies Retrograde ejaculation Prostate benign and malignant Adenocarcinoma -Bladder -Metastatic to the bladder Metastases to the Urinary Tract 151 Table 9. Differential Diagnosis of Squamous Cells in Urine Normal squamous epithelium Squamous metaplasia usually trigonal -Post inflammation -Post therapy Vaginal contamination voided urine Well-differentiated squamous carcinoma Skin 152 5. Unusual Lesions Figure . Squamous Carcinoma bladder washing Malignant squamous cells are admixed with degenerated debris crystals acute inflammation and blood. The malignant cells have an elongated appearance and the cytoplasm is keratinized. 600x