PMC1310524_01
Bladder washing, cytospin preparation, Papanicolaou stain, x400. Mixed small undifferentiated carcinoma and large urothelial carcinoma cells. The small cells are seen singly and in clusters with scanty cytoplasm, moderate cellular pleomorphism, nuclear molding, dark chromatin, irregular nuclear contour, and background of blood and necrosis consistent with a small cell carcinoma. In addition, there are a few atypical cells with a moderate amount of cytoplasm, small nucleoli, and irregular nuclear contours consistent with high-grade urothelial carcinoma. Figure 2 inset: comparison of two small cell carcinoma cells and one large urothelial carcinoma cell.
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F1
The cytological features of cytospin smears and cellblock of the bladder washing are presented in Figures 1, 2, 3, 4, &6. The cells demonstrated a moderate degree of cellular pleomorphism, nuclear molding, finely granular chromatin, hyperchromatic nuclei, and inconspicuous nucleoli in a bloody and necrotic background (Figures 1, 2, 3). The large cell population was a minor component and showed highly atypical cells with central nuclei, small nucleoli, irregular nuclear contour, and dense cytoplasm in a bloody and necrotic background (Figures 1 &2).
Bladder washing, cytospin preparation, Papanicolaou stain, x400. Mixed small undifferentiated carcinoma and large urothelial carcinoma cells. The small cells are seen singly and in clusters with scanty cytoplasm, moderate cellular pleomorphism, nuclear molding, dark chromatin, irregular nuclear contour, and background of blood and necrosis consistent with a small cell carcinoma. In addition, there are a few atypical cells with a moderate amount of cytoplasm, small nucleoli, and irregular nuclear contours consistent with high-grade urothelial carcinoma. Figure 2 inset: comparison of two small cell carcinoma cells and one large urothelial carcinoma cell.
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PMC1310524_01_1742-6413-2-18-2.jpg
F2
The cytological features of cytospin smears and cellblock of the bladder washing are presented in Figures 1, 2, 3, 4, &6. The cells demonstrated a moderate degree of cellular pleomorphism, nuclear molding, finely granular chromatin, hyperchromatic nuclei, and inconspicuous nucleoli in a bloody and necrotic background (Figures 1, 2, 3). The large cell population was a minor component and showed highly atypical cells with central nuclei, small nucleoli, irregular nuclear contour, and dense cytoplasm in a bloody and necrotic background (Figures 1 &2).
Bladder washing, cell block, H&E, x400: clusters of pure, small cell undifferentiated carcinoma of the bladder. The small cell carcinoma cells are approximately twice the size of the RBCs with finely granular chromatin and nuclear molding.
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F3
The cytological features of cytospin smears and cellblock of the bladder washing are presented in Figures 1, 2, 3, 4, &6. The cells demonstrated a moderate degree of cellular pleomorphism, nuclear molding, finely granular chromatin, hyperchromatic nuclei, and inconspicuous nucleoli in a bloody and necrotic background (Figures 1, 2, 3).
Bladder washing, cell block, H&E, x400: clusters of pure, small cell undifferentiated carcinoma of the bladder. The small cell carcinoma cells are approximately twice the size of the RBCs with finely granular chromatin and nuclear molding.
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F4
The cytological features of cytospin smears and cellblock of the bladder washing are presented in Figures 1, 2, 3, 4, &6. It showed undifferentiated malignant small cells ranging in size and shape from lymphocyte-like to intermediate type (see Figure 4 for comparison with RBC size). The cellblock (Figure 4) findings recapitulated the findings in the smears and were useful in subsequent immunohistochemical evaluations.
Cell block, H&E, x400: Urothelial carcinoma cells with a moderate amount of cytoplasm and small nucleoli.
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F6
Immunohistochemical stains were performed on cell blocks and showed positive staining of the small cell carcinoma component only for synaptophysin (Figure 5).
Bladder washing, cell block, synaptophysin immunostain of small cell carcinoma, x400. The tumor cells demonstrated cytoplasmic positivity.
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F5
The cytological features of cytospin smears and cellblock of the bladder washing are presented in Figures 1, 2, 3, 4, &6. The cell block (Figure 6) findings recapitulated the findings in the smears and were useful in subsequent immunohistochemical evaluations.
Tissue biopsy of the bladder tumor, H&E, x200. Figure 7; Small cell carcinoma. Figure 8; Urothelial carcinoma with active mitosis evident.
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F7
The histology sections (Figures 7 and 8) demonstrated a small cell carcinoma in about 80% of the tumor (Figure 7) and a high-grade urothelial carcinoma in about 20% of the tumor (Figure 8).
Tissue biopsy of the bladder tumor, H&E, x200. Figure 7; Small cell carcinoma. Figure 8; Urothelial carcinoma with active mitosis evident.
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F8
The histology sections (Figures 7 and 8) demonstrated a small cell carcinoma in about 80% of the tumor (Figure 7) and a high-grade urothelial carcinoma in about 20% of the tumor (Figure 8).
Tissue biopsy of the bladder tumor, synaptophysin immunostain. The bottom half of the section is the small cell carcinoma component of the bladder tumor which demonstrated synaptophysin positivity. The top half of the section is urothelial carcinoma that is negative for synaptophysin.
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F9
Immunohistochemical stains were performed and the tumor cells of the small cell carcinoma component were positive selectively for synaptophysin (Figure 9) and chromogranin, whereas, the high-grade urothelial carcinoma stained selectively for CK7, and CK20.