Fanning C V, Staerkel G A, Sneige N, Thomsen S, Myhre M J, Von Eschenbach A C
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Diagn Cytopathol. 1993;9(3):279-81. doi: 10.1002/dc.2840090307.
We reviewed 22 post-laser (Nd:YAG laser) coagulation bladder washes collected immediately after treatment. All washes demonstrated a striking artifact of cellular spindling. These spindled cells occurred singly, in loose clusters, and in lamellar stacks and had elongated nuclei with dense chromatin and bipolar cytoplasm that was fused in the stacks. Concurrent biopsies demonstrated similar cytologic changes. The spindling is a nonspecific epithelial response to heat. Conventionally electrocauterized epithelia show this artifact in biopsies, but since only the base of the lesion and surrounding urothelium are subjected to heat with electrocautery, the relatively few spindled epithelial cells created presumably go undetected in cytology specimens. With laser treatment, however, the whole urothelial surface of the lesion is coagulated, producing a much greater number of spindled cells. It is important to avoid misinterpreting the spindled cells as cells from a mesenchymal neoplasm or a sarcomatoid carcinoma, mistakes that were made in some of our initial cases. Malignancy cannot be evaluated when cells exhibit spindling artifact; this judgement should be made on undistorted cells. Thus, pre-laser and post-laser washes should be submitted for evaluation of malignancy.
我们回顾了22份治疗后立即收集的激光（Nd:YAG激光）凝固膀胱冲洗液样本。所有冲洗液样本均显示出明显的细胞梭形化假象。这些梭形细胞单个出现、松散成簇或呈层状堆叠，细胞核拉长，染色质致密，细胞质呈双极，在堆叠处融合。同期活检显示出类似的细胞学变化。梭形化是上皮细胞对热的一种非特异性反应。传统电灼的上皮组织在活检中也会出现这种假象，但由于电灼仅使病变底部及周围尿路上皮受热，因此产生的梭形上皮细胞相对较少，在细胞学标本中可能未被发现。然而，激光治疗时，病变的整个尿路上皮表面都会被凝固，从而产生大量梭形细胞。重要的是要避免将梭形细胞误判为间叶性肿瘤或肉瘤样癌的细胞，我们最初的一些病例就出现了这样的错误。当细胞呈现梭形假象时无法评估其是否为恶性；应根据未变形的细胞做出判断。因此，应提交激光治疗前和治疗后的冲洗液样本以评估是否存在恶性病变。
