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Calculus artifact. A challenge in urinary cytology
Acta Cytologica
|October 13, 1999
Summary
Calculus artifact in urine cytology can mimic papillary transitional cell carcinoma (TCC). Careful review is needed to distinguish artifact from true TCC, especially after calculus removal.
Area of Science:
- Uropathology
- Cytopathology
- Oncology
Background:
- Distinguishing benign cellular changes from malignancy is crucial in urine cytology.
- Calculus artifact and instrument artifact can present challenges in diagnosing transitional cell carcinoma (TCC).
Purpose of the Study:
- To compare the cytomorphologic features of calculus artifact with instrument artifact and papillary transitional cell carcinoma (TCC).
Main Methods:
- Retrospective review of voided urine specimens from patients with calculi, TCC (low and high grade), and history of instrumentation.
- Cytologic evaluation focused on nuclear and cytoplasmic features, cell arrangement, and presence of specific elements like crystals.
Main Results:
- Calculus artifact showed papillary clusters with smooth or irregular borders, cytoplasmic collars, and occasional vacuoles, sometimes with nuclear atypia.
- Instrument artifact presented with smooth-bordered papillary clusters or cell balls, lacking significant nuclear atypia.
- Transitional cell carcinoma (TCC) exhibited loss of polarity and irregular borders, with high-grade TCC showing more pronounced nuclear alterations.
Conclusions:
- Calculus artifact can mimic papillary TCC, necessitating careful evaluation.
- Nuclear atypia in calculus artifact may be reversible, unlike in TCC.
- Further investigation after calculus removal is recommended to avoid diagnostic errors.
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