Tanaka Kara, Kayraklioglu Neslihan, Chan Emily, Ding Chien-Kuang C, Vohra Poonam
Department of Pathology, University of California San Francisco, San Francisco, California, USA.
Department of Pathology, Stanford Medicine, Palo Alto, California, USA.
Cancer Cytopathol. 2025 Jan;133(1):e22914. doi: 10.1002/cncy.22914. Epub 2024 Oct 15.
Human papillomavirus (HPV)-positive urinary tract carcinomas (UTCas) have distinct morphology and molecular features with potential treatment implications. Cytomorphologic analysis of these tumors on urine cytology specimens has not yet been reported. The authors evaluated the cytomorphologic findings of HPV-positive UTCa on urine cytology using The Paris System for Reporting Urinary Cytology (TPS) criteria.
HPV-positive cases were identified by a retrospective review of surgical specimens that had UTCa confirmed by HPV in situ hybridization. Cases that had concurrent urine cytology were reviewed using TPS. Cytomorphologic features of high-grade urothelial carcinoma (HGUC) were evaluated as well as the presence of atypical squamous cells (ASCs) and basaloid features.
Sixteen cytology specimens from eight patients with HPV-positive UTCa were included. On original diagnosis, none of the cytology specimens were suggested to be HPV-associated. TPS diagnostic criteria identified eight cases with at least atypical findings, including five HGUC cases, one case that was suspicious for HGUC, and two atypical urothelial cases. Common cytomorphologic features included basaloid clusters (six of eight cases; 75%) and ASCs (four of eight cases; 50%) that matched the corresponding surgical specimens. Most cases exhibited urothelial cell hyperchromasia (seven of eight cases; 88%), and hypochromasia was a frequently observed variant (four of eight cases; 50%), either alone or in addition to hyperchromasia.
HPV-positive UTCa can be identified reliably as HGUC by using TPS criteria; however, these cases may not be recognized as HPV-associated. The presence of basaloid cells or ASCs can help suggest screening for HPV in urine specimens. Larger scale studies are warranted to validate cytomorphologic differences and determine the impact of HPV infection on clinical outcomes for patients with UTCa.
人乳头瘤病毒（HPV）阳性的泌尿道癌（UTCa）具有独特的形态学和分子特征，对治疗可能具有潜在影响。目前尚未见对这些肿瘤尿液细胞学标本进行细胞形态学分析的报道。作者采用《巴黎报告泌尿系统细胞学系统》（TPS）标准评估了HPV阳性UTCa尿液细胞学的细胞形态学表现。
通过回顾性分析经HPV原位杂交确诊为UTCa的手术标本，确定HPV阳性病例。对同时有尿液细胞学检查的病例采用TPS进行评估。评估高级别尿路上皮癌（HGUC）的细胞形态学特征以及非典型鳞状细胞（ASC）和基底样特征的存在情况。
纳入了8例HPV阳性UTCa患者的16份细胞学标本。在最初诊断时，没有一份细胞学标本提示与HPV相关。TPS诊断标准确定了8例至少有非典型表现的病例，包括5例HGUC病例、1例疑似HGUC病例和2例非典型尿路上皮病例。常见的细胞形态学特征包括基底样细胞团（8例中的6例；75%）和ASC（8例中的4例；50%），与相应的手术标本相符。大多数病例表现为尿路上皮细胞色素沉着过度（8例中的7例；88%），色素减退是常见的变异表现（8例中的4例；50%），可单独出现或与色素沉着过度同时出现。
采用TPS标准可将HPV阳性UTCa可靠地识别为HGUC；然而，这些病例可能未被识别为与HPV相关。基底样细胞或ASC的存在有助于提示对尿液标本进行HPV筛查。需要进行更大规模的研究来验证细胞形态学差异，并确定HPV感染对UTCa患者临床结局的影响。
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