Cytologic and Molecular Insights into Urothelial Carcinoma Screening in Young Patients.
Trisha M Shattuck, Rajesh Dash. Duke University Medical Center, Durham, NC
Background: Urine cytology combined with Urovysion is the standard noninvasive method of screening for urothelial carcinoma. Development of urothelial carcinoma in patients less than 40 years of age is very rare; however, cytology and Urovysion is performed on these patients to evaluate various clinical symptoms and signs. There is scant literature on findings and utility of these screening tests in this population.
Design: A search of the PathNet clinical database was performed to identify urine cytology specimens collected between January 1998 and September 2009 from patients aged 18 to 40. The clinical history; indications for study; and biopsy, imaging, cystoscopy, and Urovysion results were collected for all cytology cases with an “Atypical/Inconclusive” diagnosis or worse.
Results: The search yielded 1191 cytology accessions from 837 patients. Seventy-five percent of patients had one specimen submitted for evaluation with the remainder of patients having between two and eleven specimens submitted. The frequency of diagnoses were: Negative for Malignancy – 87%, Atypical/Inconclusive – 11%, Descriptive or Unsatisfactory – 1%. Eight cases were diagnosed as “Suspicious for Malignancy,” and no cases were “Diagnostic of Malignancy.” Seventy-five percent of patients with atypical cytology had the test performed for hematuria. Eight specimens were from patients with a history of a cancer diagnosis, including urothelial carcinoma, leiomyosarcoma, urachal carcinoma and colonic adenocarcinoma within a previous bladder reconstruction. Among specimens with atypical cytology, nephrolithiasis was the most frequently associated finding (27% of cases). Forty-four percent of patients had no cause for the hematuria or atypical cells discovered in their urologic work-up, with the majority of these undergoing both imaging and cystoscopy. All eight patients with suspicious cytology had a testing indication of hematuria. Similar to the atypical group, 25% had nephrolithiasis. All but one of these patients underwent cystoscopy with no lesions identified; one demonstrated inflammation of the bladder mucosa. Urovysion was performed on two suspicious cases and nineteen “Atypical/Inconclusive” cases. An abnormal result (loss of chromosome 9p21) was found in one of the cases with atypical cytology. However, repeat analysis was normal.
Conclusions: These results provide new insights into the cytologic and molecular findings in urine specimens from younger patients. This data may be useful in generating guidelines for the utilization of cytology and Urovysion in screening of patients with these demographics.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 63, Monday Morning