Owens Christopher L, Ali Syed Z
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287-6417, USA.
Diagn Cytopathol. 2005 Dec;33(6):394-8. doi: 10.1002/dc.20344.
Presence of atypical squamous cells (ASC) in voided urine is an uncommon finding that may be the harbinger of an underlying malignant process. ASCs in urine may precede a de novo histologic diagnosis of malignancy or be the first sign of a recurrence in the lower urinary tract, or the gynecologic tract (in women). This study analyzed all urine cytology specimens with such diagnoses, with reference to their final histologic outcome. All urine cytology cases (n = 17,446) that included ASCs, evaluated at The Johns Hopkins Hospital between 1989 and 2003 (14 yr), were reviewed for diagnoses. ASCs as defined in this study are keratinizing cells with large and hyperchromatic smudgy nuclei, high N/C ratio, abnormal nuclear or cytoplasmic shapes, and densely orangeophilic cytoplasm. These cases lacked the qualitative and quantitative criteria for malignancy. The final reference outcome was determined by subsequent histologic and clinical follow-up. Of these 17,446 urine specimens, 55 cases (0.3%) from 47 patients had ASCs present. Thirty-two of the 47 patients had adequate follow-up. In 8 of these 32 patients (25%), a diagnosis of squamous-cell carcinoma (SCC) of the urinary bladder or urothelial carcinoma (UC) with squamous differentiation was made on subsequent histologic examination. In two cases (6%) a diagnosis of high-grade cervical SCC was established on subsequent follow-up. Twenty two of 32 cases (69%) remained benign on histologic and prolonged clinical follow-up. We conclude that ASCs in urine are rare (0.3% in this series). An interpretation of ASCs in a urine specimen is made when there is insufficient qualitative/quantitative evidence for a carcinoma diagnosis. ASCs in urine are a clinically valid diagnostic category (31% were later diagnosed with SCC). Most patients with urinary ASCs do not develop malignancy and, therefore, these cells may represent a reactive/inflammatory process most commonly due to vaginal contamination (in women) or exfoliation from the distal urethra (in men). Rarely, ASCs may exfoliate from a uterine cervical SCC and, therefore, a pelvic examination should be considered in such patients.
排尿中出现非典型鳞状细胞（ASC）是一种不常见的发现，可能是潜在恶性病变的先兆。尿液中的ASC可能先于恶性肿瘤的组织学诊断，或者是下尿路或女性生殖道复发的首个迹象。本研究分析了所有有此类诊断的尿液细胞学标本，并参考其最终组织学结果。对1989年至2003年（14年）期间在约翰霍普金斯医院评估的所有包含ASC的尿液细胞学病例（n = 17446）进行诊断复查。本研究中定义的ASC是具有大的、染色质增多的模糊核、高核质比、异常核或细胞质形态以及浓密嗜橙色细胞质的角化细胞。这些病例缺乏恶性肿瘤的定性和定量标准。最终参考结果通过后续组织学和临床随访确定。在这17446份尿液标本中，47例患者的55份标本（0.3%）存在ASC。47例患者中有32例进行了充分随访。在这32例患者中的8例（25%），后续组织学检查诊断为膀胱鳞状细胞癌（SCC）或伴有鳞状分化的尿路上皮癌（UC）。在2例（6%）患者中，后续随访诊断为高级别宫颈SCC。32例中的22例（69%）在组织学和长期临床随访中保持良性。我们得出结论，尿液中的ASC很少见（本系列中为0.3%）。当缺乏足够的定性/定量证据进行癌症诊断时，对尿液标本中的ASC进行解读。尿液中的ASC是一个临床有效的诊断类别（31%后来被诊断为SCC）。大多数有尿液ASC的患者不会发生恶性肿瘤，因此，这些细胞可能代表一种反应性/炎症过程，最常见的原因是女性的阴道污染或男性远端尿道的脱落。ASC很少从宫颈SCC脱落，因此，此类患者应考虑进行盆腔检查。
