Abstract：
BACKGROUND: Compared to urothelial carcinomas (UCs), the cytomorphology of renal cell carcinomas (RCCs) is underdescribed. This study aims to investigate whether UCs and RCCS of the upper urinary tract can be differentiated cytologically, and to identify distinguishing cytomorphological features.
METHODS: Consecutive urine cytology specimens with atypical/C3, suspicious/C4 or malignant/C5 diagnoses matched with a nephrectomy or ureterectomy specimen with UC or RCC over a 15-year period were reviewed for cellularity, architecture, background composition and cytomorphologic features.
RESULTS: Totally 132 specimens were retrieved, comprising 24 RCCs and 108 UCs. Clear cell RCC (CCRCC) (n = 18) was the most common RCC. Urine cytology specimens from UC showed a trend of higher cellularity (p = 0.071) against RCC and was significant in subgroup analysis with CCRCC (p < .001). Epithelial structures in sheets, tubules, and papillae were exclusive in specimens of UC (p < .05). For background features, squamous cells were more common for RCC (p = .006) including CCRCC (p = .003), whereas polymorphs (p = .011) and necrotic material (p = .010) were associated with UC. Average nuclear size was larger and nuclear size variation (p < .001) and nuclear-cytoplasmic ratio (p = .001) were greater in UC (p = .001) than RCC. Comparing RCC to high-grade UCs only, nuclear-cytoplasmic ratio maintained statistical significance (p = .006) while average nuclear size showed a trend (p = .063).
CONCLUSIONS: A clean background free of tumor necrosis and polymorphs, and the lack of complex tumor fragments favors RCC. UCs also display larger nuclear size, higher nuclear size variation and nuclear-cytoplasmic ratio. These cytomorphological features with corroboration of clinical/radiological findings, can aid in raising a diagnosis of RCC.
METHODS: Consecutive urine cytology specimens with atypical/C3, suspicious/C4 or malignant/C5 diagnoses matched with a nephrectomy or ureterectomy specimen with UC or RCC over a 15-year period were reviewed for cellularity, architecture, background composition and cytomorphologic features.
RESULTS: Totally 132 specimens were retrieved, comprising 24 RCCs and 108 UCs. Clear cell RCC (CCRCC) (n = 18) was the most common RCC. Urine cytology specimens from UC showed a trend of higher cellularity (p = 0.071) against RCC and was significant in subgroup analysis with CCRCC (p < .001). Epithelial structures in sheets, tubules, and papillae were exclusive in specimens of UC (p < .05). For background features, squamous cells were more common for RCC (p = .006) including CCRCC (p = .003), whereas polymorphs (p = .011) and necrotic material (p = .010) were associated with UC. Average nuclear size was larger and nuclear size variation (p < .001) and nuclear-cytoplasmic ratio (p = .001) were greater in UC (p = .001) than RCC. Comparing RCC to high-grade UCs only, nuclear-cytoplasmic ratio maintained statistical significance (p = .006) while average nuclear size showed a trend (p = .063).
CONCLUSIONS: A clean background free of tumor necrosis and polymorphs, and the lack of complex tumor fragments favors RCC. UCs also display larger nuclear size, higher nuclear size variation and nuclear-cytoplasmic ratio. These cytomorphological features with corroboration of clinical/radiological findings, can aid in raising a diagnosis of RCC.
摘要：
背景：与尿路上皮癌（UC）相比，肾细胞癌（RCC）的细胞形态学未被描述。本研究旨在探讨上尿路的UCs和RCCS是否可以在细胞学上进行区分。并识别细胞形态学特征。
方法：连续的尿液细胞学标本，其诊断为非典型/C3，可疑/C4或恶性/C5，并与UC或RCC的肾切除术或输尿管切除术标本相匹配，为期15年。architecture,背景组成和细胞形态学特征。
结果：共检索到132个标本，包括24个RCC和108个UC。透明细胞RCC（CCRCC）（n=18）是最常见的RCC。来自UC的尿细胞学标本显示出针对RCC的较高细胞含量的趋势（p=0.071），并且在CCRCC的亚组分析中具有显着意义（p<.001）。床单中的上皮结构，小管,和乳头在UC标本中是唯一的（p<0.05）。对于背景功能，鳞状细胞更常见于RCC（p=.006），包括CCRCC（p=.003），而多晶型物（p=.011）和坏死物质（p=.010）与UC相关。UC（p=.001）的平均细胞核大小较大，细胞核大小变化（p<.001）和核质比（p=.001）大于RCC。仅将RCC与高品位UC进行比较，细胞核-细胞质比率保持统计学显著性(p=.006),而平均细胞核大小显示出趋势(p=.063)。
结论：干净的背景没有肿瘤坏死和多晶型物，缺乏复杂的肿瘤片段有利于RCC。UC也显示更大的核尺寸，较高的核大小变异和核质比。这些细胞形态学特征证实了临床/放射学发现，可以帮助提高RCC的诊断。
方法：连续的尿液细胞学标本，其诊断为非典型/C3，可疑/C4或恶性/C5，并与UC或RCC的肾切除术或输尿管切除术标本相匹配，为期15年。architecture,背景组成和细胞形态学特征。
结果：共检索到132个标本，包括24个RCC和108个UC。透明细胞RCC（CCRCC）（n=18）是最常见的RCC。来自UC的尿细胞学标本显示出针对RCC的较高细胞含量的趋势（p=0.071），并且在CCRCC的亚组分析中具有显着意义（p<.001）。床单中的上皮结构，小管,和乳头在UC标本中是唯一的（p<0.05）。对于背景功能，鳞状细胞更常见于RCC（p=.006），包括CCRCC（p=.003），而多晶型物（p=.011）和坏死物质（p=.010）与UC相关。UC（p=.001）的平均细胞核大小较大，细胞核大小变化（p<.001）和核质比（p=.001）大于RCC。仅将RCC与高品位UC进行比较，细胞核-细胞质比率保持统计学显著性(p=.006),而平均细胞核大小显示出趋势(p=.063)。
结论：干净的背景没有肿瘤坏死和多晶型物，缺乏复杂的肿瘤片段有利于RCC。UC也显示更大的核尺寸，较高的核大小变异和核质比。这些细胞形态学特征证实了临床/放射学发现，可以帮助提高RCC的诊断。
