Pap stain, High power
Showing homogenous cytoplasm, central nuclear location and irregular cytoplasmic borders
Pap stain, medium power
Atypical appearing cells with low NC ratios, smudgy chromatin and variable shapes. Note that unlike the high grade carcinoma cells, the nuclear membranes are smooth and chromatin is not coarse. In therapy related atypia, the clusters of low grade carcinoma or stone related atypia are NOT seen either.
Pap stain, high power
Examples of therapy related atypia in this patient with BCG therapy.
Note the cells are singly arranged and have smudgy chromatin. Note that cell shapes are polygonal and in some cells the cytoplasmic edges are frayed.
Pap stain, high power
Two atypical cells (tadpole like and histiocytoid) with round to oval nuclei and smudgy chromatin.
Please note the N:C ratio is not increased.
Pap stain, high power
Atypical cell with almost tadpole like shape. Note that nuclear membrane is irregular and chromatin is NOT hyperchromatic
Features
• BCG therapy
• Thiotepa and Mitomycin
• Predominantly single cell pattern
• Histiocytoid cells
• Abundant cytoplasm
• Cytoplasm may show coarse vacuolation (very rare in malignant cells)
• Frayed cytoplasmic borders
• Low nucleus to cytoplasmic ratio
• Centrally located nucleus
• Smudgy chromatin
• Smooth nuclear contour
• May see multinucleated cells
• Atypia can be caused by radiation changes as well. Please see the chapter of Gynecologic Cytology for examples of radiation changes in exfoliative cytology.
Takashi M et al. Urol Int. 2000;64(2):74-81.