Policarpio-Nicolas Maria Luisa C, McIntire Patrick J
Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Diagn Cytopathol. 2025 Feb;53(2):72-75. doi: 10.1002/dc.25419. Epub 2024 Nov 5.
Therapeutic modalities used in bladder lesions/neoplasms (electrocautery, fulguration, and laser) could produce morphologic alterations leading to diagnostic challenges. While often seen on histology, they can present in urine cytology as atypia or even raise the concern for malignancy. Herein, we present clinicopathologic findings of four patients with cautery artifact in urine cytology.
The authors' lists and a computerized search of urine cytology with features of thermal cautery artifact were collated. Slides and clinicopathologic variables (prior specimens, concurrent and follow-up surgical specimens, age, sex, manner of urine collection, cystoscopy, and treatment procedure during cystoscopy) were reviewed.
Four cases were identified. Procedures performed during cystoscopy included laser therapy (n = 2), postbiopsy cauterization (n = 1), and fulguration (n = 1). All cases showed spindled cells with delicate bipolar cytoplasm, "cigar-shaped" nuclei, smooth to slightly irregular nuclear membranes, and arranged singly and loosely cohesive to lamellar stacks. Few atypical well-preserved, undistorted cells were identified in 2/4. The concurrent biopsies showed superficial cellular fragments with thermal artifact (n = 1) and rare atypical cells (n = 2). Follow-up biopsies in two cases had high-grade urothelial carcinoma both of which were diagnosed as atypical urothelial cells on cytology.
Thermal cautery artifact in urine cytology is rare and can be seen following laser, electrocautery, and fulguration. The spindling artifact can render some degree of difficulty in assessing for the presence of urothelial atypia both in cytology and biopsy. Familiarity with these cytologic features, knowledge of the treatment procedure, attention to the cytologic findings of well-preserved cells and repeat sampling in cases with atypical urothelial cells in patients with history of malignancy is essential.
用于膀胱病变/肿瘤的治疗方式（电灼、电凝和激光）可能会产生形态学改变，从而带来诊断挑战。虽然这些改变在组织学检查中经常可见，但在尿液细胞学检查中可能表现为异型性，甚至引发对恶性肿瘤的担忧。在此，我们展示了4例尿液细胞学检查中出现烧灼假象的临床病理结果。
整理了作者的病例清单以及对具有热烧灼假象特征的尿液细胞学检查进行的计算机检索。回顾了玻片以及临床病理变量（先前的标本、同期和随访手术标本、年龄、性别、尿液采集方式、膀胱镜检查以及膀胱镜检查期间的治疗程序）。
共识别出4例。膀胱镜检查期间进行的操作包括激光治疗（n = 2）、活检后烧灼（n = 1）和电凝（n = 1）。所有病例均显示梭形细胞，胞质纤细呈双极状，核呈“雪茄形”，核膜光滑至略不规则，单个排列，松散聚集或形成层状堆叠。4例中有2例发现少量保存良好、未变形的非典型细胞。同期活检显示有热假象的浅表细胞碎片（n = 1）和罕见的非典型细胞（n = 2）。2例随访活检发现高级别尿路上皮癌，这2例在细胞学检查中均被诊断为非典型尿路上皮细胞。
尿液细胞学检查中的热烧灼假象罕见，可在激光、电灼和电凝后出现。这种梭形假象在细胞学检查和活检中评估尿路上皮异型性时可能会造成一定困难。熟悉这些细胞学特征、了解治疗程序、关注保存良好细胞的细胞学表现以及对有恶性肿瘤病史且出现非典型尿路上皮细胞的病例进行重复采样至关重要。
