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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2005.10.004 Byline: Kristine E. West (a), Eva M. Wojcik (b), Teri A. Dougherty (a), Kalliopi P. Siziopikou (c), Kathy S. Albain (d), Sheryl G.A. Gabram (a) Keywords: Ductal lavage; Breast cytology; Breast histology Abstract: The use of ductal lavage to obtain cells from within the breast ducts has been described for patients at high risk for breast cancer. The purpose of this study was to correlate ductal lavage cytologic findings with the corresponding histology. Author Affiliation: (a) Department of Surgery, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, USA (b) Department of Pathology, Loyola University Medical Center, Maywood, IL, USA (c) Department of Pathology, Rush University Medical Center, Maywood, IL, USA (d) Department of Medicine Loyola University Medical Center, Maywood, IL, USA Article History: Received 19 July 2004; Revised 15 November 2004

Following the amazing acceptance of The Paris System for Reporting Urinary Cytology (TPS), the second edition (TPS 2.0) was inevitable. Based on new studies since the publication of the first edition, diagnostic criteria are refined, and pitfalls discussed. In addition to reinforcing the mandate that the focus of diagnostic urinary cytology is the detection of high-grade urothelial carcinoma, other issues are addressed. Low-grade lesions are included in the category of negative for high-grade urothelial cancer. The rationale for that decision is strongly supported by evidence from the authors’ experiences as well as the recent literature. A new chapter on urine cytology of the upper tract, a rarely addressed topic, explores the challenges involved. Furthermore, the issue of cellular degeneration is discussed in the criteria of all diagnostic categories. Most importantly, data defining the risk of high-grade malignancy (ROHM) for each diagnostic category informs clinical management. The 65 authors are recognized authorities from 33 countries, attesting to the global impact of TPS 2.0.

The Paris System (TPS) for Reporting Urinary Cytology (UCyto) was published in 2016, but to date, no study addressing the unsatisfactory (UNSAT) category has been published. We aimed to identify the negative predictive value (NPV) for UNSAT UCyto after the implementation of TPS at our institution.

The Paris System for Reporting Urinary Cytology (TPS) was developed for standardization purposes and it placed an emphasis on screening for high-grade urothelial carcinoma (HGUC). Since then, it has shown to reduce atypia rates and better correlate with surgical specimens. The aim of this study was to calculate the negative predictive value (NPV) of urinary cytology for detecting HGUC using TPS and compare these data to our recently published pre-TPS cohort. As a screening test, it is imperative that TPS has a high NPV.

The color of urine, once considered by uroscopists to give the most important clues to the diagnosis, still can provide some diagnostic clues in modern medicine. Pigmented cells are an uncommon and surprising find in urine cytology and can at the same time provide important diagnostic clues or represent a dangerous pitfall. We present a review of the significance of pigmented cells in urine cytology. The presence of intracellular pigment granules; their color, size, shape, and variation in size and shape; as well as their staining reactions with special stains can provide useful diagnostic insight, especially when interpreted in the cytologic context (type of pigmented cell and its degree of atypicality) and patient’s clinical context. The main differential diagnosis of cytoplasmic pigmented granules includes hemosiderin, lipofuscin, and melanin, each having a different pathogenesis and significance. The goal of this paper is to describe the morphological, histochemical, and ultrastructural characteristics of the pigments seen in urinary cytology, and to review the benign and malignant conditions associated with them.

Rosai-Dorfman disease (RDD) is a rare usually self-limited non–Langerhans cell histiocytosis of unknown etiology. Nodal and extranodal RDD appear to represent distinct conditions with different molecular alterations and prognosis. They also pose different diagnostic challenges on biopsies and fine-needle aspiration (FNA) cytology. The aim of this study was to report on 3 cases of intra-abdominal RDD and perform an extensive review of the literature on FNA findings of RDD.

In concert with the 2015 publication of The Paris System for Urinary Cytopathology (TPS), a Web-based interobserver study, co-sponsored by the American Society of Cytopathology (ASC) and International Academy of Cytology (IAC), was performed to determine diagnostic agreement among volunteer participants and with the TPS author consensus.

The main purpose of urine cytology is to detect high-grade urothelial carcinoma. With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of high-grade urothelial carcinoma. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. TPS Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme’s universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.

Urinary tract cytology (UTCy) allows the accurate diagnosis of high grade urothelial carcinoma. Rare malignancies characterized by the presence of small cells may be more difficult to recognize, however. The aim of this study was to review our experience with liquid-based (ThinPrep) UTCy specimens showing small atypical cells and characterize their cytomorphology, potential differences from previously reported morphologic features, and discuss their differential diagnostic considerations.

The diagnosis “atypical urothelial cells (AUC)” remains an unresolved problem, making many urologists dissatisfied and confused about the management strategy on these cases. To date, a few inspiring attempts were made to subclassify AUC into “atypical urothelial cells of undetermined significance” (AUC-US) and “atypical urothelial cells cannot exclude high grade” (AUC-H). The aim of our study was to investigate the most predictive for high-grade urothelial carcinoma (HGUC) cytomorphologic parameters and whether the proposed classification can be implemented in our institution.

Adequacy criteria are well established in some areas of cytopathology to prevent false negative diagnoses. To date, no such criteria have been proposed and validated for urinary tract specimens. Our aim was to determine a cellularity cutoff point that significantly affects the sensitivity of detecting high-grade or in situ urothelial carcinoma (HGUC or UCIS) in bladder barbotage/washing specimens.

The ability to consistently diagnose low-grade urothelial carcinoma (LGUC) in urinary tract cytology (UTCy) specimens remains controversial, as the reported sensitivity of UTCy in the detection of LGUC is as low as 10%. To determine whether a consistent cytologic diagnosis of LGUC is possible, we assessed the presence and frequency of previously described cytomorphologic features of LGUC in UTCy from patients with LGUC and a negative control group.

Upper tract urothelial carcinoma (UTUC) is defined as urothelial carcinoma (UC) arising in the renal pelvis and ureter. Upper tract (UT) cytology and biopsy evaluation can be technically challenging. The aim of the study is to evaluate the diagnostic modality and sensitivity of urine cytology and ureteroscopic biopsy for the diagnosis of UTUC.

The term “atypia,” although not well characterized, is widely used in diagnostic surgical and cytopathology. Because there are no guidelines regarding when to use this term, in the majority of cases, it is used as a “wastebasket.” This definitely applies to urine cytology, where the reported rate of atypia ranges from 1.9% to 23%. This review lists a number of cytomorphologic findings in urine cytology that are associated with known and specific causes. Urine specimens in which the morphologic changes can be attributed to particular etiologic factors should no longer be classified as “atypical.” These include urine specimens showing reactive umbrella cells or seminal vesicle cells, reactive changes due to stones, cytologic changes characteristic of infectious processes or therapy effect, instrumented urines with pseudopapillary clusters, and urinary diversion specimens.

BACKGROUND.Urine cytology plays an important role in monitoring patients with a history of urothelial carcinoma. Because it is difficult to reliably discriminate artifacts induced by instrumentation, inflammation, or therapy those of from malignant cells, many of these specimens are categorized as atypical. The objective of the current study was to study the prevalence and significance of atypical urine cytology with regard to the effect of instrumentation and prior biopsy.METHODS.All urine cytology cases seen during a 4year period 20012004 with a diagnosis of atypical urothelial cells AU were obtained from the cytopathology computer database. In all cases with available surgical followup, the following data were extracted: total number and type of urine specimen, the primary histologic diagnosis, and followup histologic diagnosis.RESULTS.In all, 1653 voided and 3502 instrumented urine specimens were examined. A diagnosis of AU was rendered in 115 6.9 of the voided urine specimens and in 277 7.9 of the instrumented specimens. Followup histology was available in 70 cases, including 55 instrumented and 15 voided urine specimens. A nonbenign followup diagnosis was observed in 18 of 55 32.7 cases in the instrumented group and in 7 of 15 46.6 cases in the voided group. Voided urine was marginally associated with a worse subsequent biopsy diagnosis Pexact Monte Carlo .09CONCLUSIONS.An AU diagnosis is more predictive of a subsequent adverse biopsy diagnosis in voided urine specimens compared with instrumented urines. In the absence of a benchmark for the atypia rate, it is prudent to keep the atypia rate low to keep it more meaningful. This important category should be used by the pathologist to convey concern and recognize the difficulty in interpretation of specimens that may require close followup. Cancer Cancer Cytopathol 2008. © 2008 American Cancer Society.

•Impossible to diagnose LGUC on urine?•Enter “TPS” in 2016.•Special edition has papers addressing gaps found in TPS 1.0.•New modalities/techniques highlighted.•Looking forward to TPS 2.0.

Pathologists exhibit very poor agreement in adjudicating the cause of cytologic-histologic correlation discrepancies, which contributes to problems in designing interventions to reduce discrepancy frequency. In this observational study, we developed a visual method of adjudicating discrepancy cause, termed the No-Blame Box method, which consisted of initially assessing specimen interpretability by separately evaluating specimen quality and the presence of tumor. Five pathologists blindly adjudicated the cause of discrepancy in pulmonary specimens from 40 patients. The kappa statistic of all pathologist pairs in adjudicating discrepancy cause using the No-Blame Box method ranged from 0.400 to 0.796, indicating acceptable to excellent agreement. Pathologists ranged in their assessment of specimen interpretability from 13% to 20%, and in no case did all 5 pathologists concur that a specimen was interpretable. Most discrepancies resulted from pathologists diagnosing noninterpretable samples. Pathologists who used the No-Blame Box showed significant agreement in the adjudication of discrepancy cause.

Cervical cytology is the most logical area to introduce automation into daily practice. The Papanicolaou test is extremely labor intensive and, therefore, at risk for human errors. Automated screening of cervical tests has been attempted for many years with the hope of improving sensitivity and specificity, as well as increasing productivity. Over the years, numerous systems have been introduced. The early ones failed mostly because computer capabilities could not handle the enormous amount of information required to differentiate normal from abnormal cells. Recent improvements in the processing power of computers have made the practical application of automated devices possible. In the process of developing automated screening systems, it was realized that the method of specimen processing (smearing a sample over a glass slide) is not an optimal one. As such, mostly as a byproduct, liquid-based technology was introduced. Despite early concerns regarding morphology and, more important, cost, liquid-based preparations have become so successful that, in practice, they have become the standard of care. Similar concerns regarding additional cost are raised against currently available automated systems. Clinical daily practice will show if these concerns are valid.

Historically, the diagnostic accuracy of urine cytology for the detection of urothelial carcinoma has been low, particularly for low‐grade lesions. In 1998, the World Health Organization and International Society of Urologic Pathologists (WHO/ISUP) established a new classification system for urothelial neoplasms. It has been postulated that the accuracy of urine cytology for the detection of low‐grade carcinomas should improve, because the current WHO/ISUP system classifies bladder lesions that lack any significant cytologic atypia as papillary urothelial neoplasms of low malignant potential (PUNLMP). Also, the accuracy of urinary cytology for the detection of high‐grade lesions is expected to decrease, because the criteria for high‐grade lesions is lowered, placing most of the previous WHO Grade 2 tumors into the current high‐grade carcinoma category.One hundred bladder biopsies that were classified according to the previous WHO classification system were examined by one pathologist and were reclassified according to the new WHO/ISUP scheme. All biopsies had corresponding urine specimens that had been diagnosed previously by a different cytopathologists. The patients' previous WHO and current WHO/ISUP surgical diagnoses were compared with the corresponding urine cytology. In addition, cytospins obtained from 40 patients with a histologic diagnosis of low‐grade urothelial carcinoma (n = 20 patients) and high‐grade urothelial carcinoma (n = 20 patients) according to the WHO/ISUP classification system were reviewed to identify any outstanding cytologic features.According to the original WHO classification system, there were 26 patients with Grade 1 transitional cell carcinoma (TCC), 61 patients with Grade 2 TCC, and 13 patients with Grade 3 TCC. The corresponding cytology was positive in 11 of 26 Grade 1 tumors, 28 of 61 Grade 2 tumors, and 12 of 13 Grade 3 tumors. After the reclassification, there was 1 papilloma, 12 PUNLMP lesions, 50 low‐grade urothelial carcinomas, and 37 high‐grade carcinomas. The cytology was positive in 0 of 1 papillomas, 5 of 7 PUNLMP lesions, 18 of 50 low‐grade carcinomas, and 28 of 37 high‐grade carcinomas. In addition, morphologic uniformity and cytoplasmic homogeneity (50.0% and 45.0%, respectively) were seen more commonly in low‐grade bladder tumors.The diagnostic accuracy of urine cytology for high‐grade lesions decreased, as expected; however, cytologic detection of low‐grade urothelial carcinomas was remarkably lower than expected. In addition, no outstanding cytologic features could be identified to make a definitive diagnosis. Cancer (Cancer Cytopathol) 2002. © 2002 American Cancer Society.

Cellular angiofibroma (CAF) is a recently described rare soft tissue neoplasm of the vulva (with only four reported cases) that typically occurs as a well-circumscribed solid rubbery vulvar mass in middle-aged women. The distinct histologic features of bland spindle cells admixed with numerous hyalinized medium to small blood vessels, and a vimentin-positive desmin-negative immunoprofile differentiates this neoplasm from other vulvar tumors such as angiomyofibroblastoma and aggressive angiomyxoma. In this report an additional case of CAF is presented with DNA ploidy analysis and CD99 immunohistochemistry.

Prognosis of infants born with sacrococcygeal teratomas (SCTs) correlates with gestational age (GA). The survival rate after 30 weeks of gestation is 75%, compared to 7% before 30 weeks of gestation. Studies correlating GA with size, morphologic composition of teratomas, ploidy or expression of cell cycle control proteins such as p53, and ret [a tyrosine kinase receptor of the GDNF (glial cell line–derived neurotrophic factors)] receptor family may provide information explaining differences in survival. Seven SCTs (GA 21 to 41 weeks), ranging in size from 5 to 15 cm, were evaluated for morphologic composition. DNA ploidy was assessed in mature and immature neural elements. Immunohistochemical reactivity with monoclonal antibodies recognizing p53, and ret was quantitated and correlated with morphological pattern and GA. Relative size of teratomas to infants' weight and content of immature neural tissues correlated inversely with advancement of GA. Yolk sac tumor (YST) and immature tissues showed aneuploid cell populations. Nuclear p53 reactivity was apparent in the teratoma with YST in the microcystic patterns, the neuroectodermal rosettes, and the glandular patterns. Ret reactivity was seen in osteoclasts adjacent to bone formation surrounding developing teeth in an immature teratoma, and in rare mature neural cells of one SCT of 35 weeks GA. The rapid growth of SCT (GA <30 weeks) correlates with increase in immature neural tissues. Our study confirms aneuploidy in YST and suggests aneuploid populations within immature tissues. p53 accumulates in a variety of patterns of YST and may be seen in immature components of SCTs. To understand the possible role of ret, further studies comparing ret expression in immature human tissues are needed.

Telecytology offers a suitable solution to the cost and time efficiency questions on ROSE. An increasing number of institutions are adopting new telecytology systems to meet the increasing ROSE requests, however, there is no agreement on the details of how a telecytology validation study needs to be conducted. We propose a standardized approach for telecytology validation studies that could be done in a variety of practices.

This study was conducted to determine if an incidence of hypodiploidy in urinary specimens is related to seasonal temperature changes. DNA ploidy was evaluated on 10,846 urinary specimens fixed in buffered alcohol (MOPSO/NaCl + ETOH) and received over a one year period from numerous sites throughout the United States. The percentage of hypodiploid (DNA index &lt; 0.8) cases was evaluated in each month. As a control, DNA ploidy results from 3,755 prostate biopsies, fixed in 10% neutral buffered formalin, received during the winter and summer months of the same year, were evaluated. The average percentage of hypodiploidy in cytologic specimens during the summer months was 19.6% compared to 5.4% in the winter and early spring months (range: 20.6–4.8%). The average percentage of hypodiploid cells in histologic specimens was 0.8% for both the summer and winter months (range: 1.73–0.36%). The rate of hypodiploidy in urinary cytology seems to be temperature related. The hypodiploidy rate of histologic specimens fixed in formalin shows no fluctuation with the seasons. Cytometry (Comm. Clin. Cytometry) 42:218–220, 2000. © 2000 Wiley-Liss, Inc.

Abstract: We present a rare case of carcinosarcoma of the prostate occurring in a 60-year-old white male. This diagnosis was initially missed after a transurethral resection of the prostate (TURP) had been performed to alleviate the patient's urinary obstructive symptoms. After recurrence of symptoms within a short period, another TURP was performed and the diagnosis of carcinosarcoma was then established. The patient then underwent a radical cystourethroprostatectomy with bilateral lymphadenectomy and ileal conduit diversion. Carcinosarcoma of the prostate is a very aggressive disease that often has a poor prognosis, especially when it has spread out of the prostate. Surgical removal of the prostate seems to be the best option for treatment in the select group of patients in which the disease remains confined to the prostate.