Evaluation of Enteric Urine Specimens: Challenging Specimens in a High Risk Population

Autor: Genevieve M. Crane, Christopher J. VandenBussche, Dorothy L. Rosenthal
Rok vydání: 2014
Předmět:
Zdroj: Journal of the American Society of Cytopathology. 3:S32
ISSN: 2213-2945
DOI: 10.1016/j.jasc.2014.09.066
Popis: Introduction: To improve prognostic value and enable more standardized clinical management, our group has recently developed a standardized template for urologic tract (UT) cytology specimens. We now examine the application of this template to enteric urine specimens. These specimens create a diagnostic challenge due to the often rarity of urothelial cells compared to enteric contaminant and increased degenerative changes. These patients are at high risk for recurrence and screening methods, including endoscopy, are technically difficult due to the altered anatomy, making accurate cytologic diagnosis particularly crucial in these specimens. Materials and Methods: The database was searched over a 10-year period to identify enteric urologic specimens with evidence of high grade urothelial carcinoma [HGUC]or atypical urothelial cells. Cytologic characteristicswere evaluated along with clinical data including prior history of carcinoma, surgical resection/reconstruction, pathologic staging/diagnosis, and the role of abnormal urine cytology in guiding subsequent treatment decisions. Results: 11 patients with 19 instances of abnormal urine cytology were identified. Most cases represented recurrence of HGUC following radical cystoprostatectomy, with one case of adenocarcinoma. All patients were male and had reconstruction with ileum, 3 of which were orthotopic neobladders. The median age was 72 and the median time to recurrence from cystectomy was 16 months. 6 of 11 patients were deceased at the time of analysis, all with extensive metastatic disease. Of those that were deceased, median time from positive cytology to death was 2.2 years. When the site of recurrence could be detected, it was close to the prior ureteral anastomosis in 5 cases and amenable to surgical treatment. Conclusions: Patients with recurrent HGUC following radical cystoprostatectomy have a high rate of mortality with limited treatment options. Our findings demonstrate that positive urine cytology may frequently identify surgically-resectable recurrences, suggesting these patients may benefit from close follow-up and standardized evaluation.
Databáze: OpenAIRE
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