Urinary Tract

Question 1

They’re large, flat, polygonal cells, measuring 15-30μm in diameter.

Cell formations: isolated or sheets and clusters
 Nuclei: one or two, relatively large, round to oval, central or eccentric,
multinucleation common.

 Chromatin: pale, finely granular, salt and pepper appearance (small chromatin
granules are separated by relatively clear nucleoplasm).
 Nuclear membrane: smooth, well-defined.
 Nucleoli: small, inconspicuous or absent.
 Cytoplasm: well defined, cyanophilic, may be finely vacuolated.
 The N/C ratio is high

Answer 1

Transitional cells

Question 2

Cell formations: small aggregates with a glandular of ball-like configuration.
 Cells: small, columnar or round.
 Cytoplasm: slightly acidophilic, vacuolated, or granular, distinct cell membranes.
 Nucleus: single, small, round to oval.
 Chromatin: finely granular.

Answer 2

Prostatic cell

Question 3

Cells: smaller than transitional cells and almost always degenerated.
 Nuclei: enlarged, hyperchromatic, uniformly smudged or glassy.
 Chromatin: little or no chromatin structure.
 These cells can also be identified by the presence of cytoplasmic golden brown
lipochrome pigment and vacuoles.

Answer 3

Seminal vesicle cells

Question 4

Cells: small, round, cuboidal, or columnar cells.
 Nuclei: small, round, hyperchromatic.
 Nucleoli: occasional small.
 Cytoplasm: variable amount, eosinophilic or amphophilic, distinct cell borders.
 These cells are usually degenerated and may resemble histiocytes.

Answer 4

Renal tubular cells

Question 5

This infection is characterised by budding

yeast and pseudohyphae.

Answer 5

Candida species

Question 6

They appear as blue-grey pear shaped organisms with a small crescent shaped
nucleus and red granules in the cytoplasm.

Answer 6

Trichomonas vaginalis

Question 7

The characteristic ova with terminal spines and refractive shell as well as an
abundance of metaplastic squamous cells

Answer 7

Schistosoma

Question 8

Single or multinucleated transitional cells with a characteristic “ground glass”
nuclear appearance or typical eosinophilic intranuclear inclusions surrounded by a
halo are seen.
 Nuclear moulding and margination of the chromatin are characteristic features.

Answer 8

Herpes simplex virus

Question 9

This virus results in the appearance of
enlarged tubular cells, with an enlarged nucleus, which contains a single,
irregular, cyanophilic, central “owl-eye” inclusion, surrounded by a halo and
thickened nuclear membrane

Answer 9

Cytomegalovirus

Question 10

Smears show characteristic epithelial cells (“decoy cells”).
 Nuclei: enlarged, round to oval, eccentric, may be binucleated, almost completely
filled with a homogenous, dark, basophilic inclusion, N/C ratio is high and may
mimic carcinoma, spherical non-encapsulated viral particles present singly or in
loose crystalline arrays within the nuclei are seen by electron microscopy.
 Nuclear membrane: markedly thickened, smooth.
 Chromatin: clumped along the periphery, thin halo may separate the inclusion
from the clumped chromatin.
 Viral particles may leach out of the cells resulting in a coarse “fishnet” chromatin
appearance, which is also characteristic

Answer 10

Polyoma virus

Question 11

Infected cells may show atypia, koilocytosis and dyskeratosis identical to cervical
lesions.

Answer 11

Human papilloma virus

Question 12

Associated with intracytoplasmic
eosinophilic inclusions
and multinucleated syncytia of epithelial cells

Answer 12

Measels

Question 13

Single or multiple, cyanophilic, concentrically lamellated inclusions,
referred to as Michaelis-Gutman bodies, are present within the macrophages.
 These structures are seen along with macrophages, multinucleated giant cells,
and occasional leukocytes in the bladder submucosa, resulting in characteristic
yellow plaques.

Answer 13

Malakoplakia

Question 14

Large eosinophilic intranuclear inclusion

surrounded by a halo in desquamated renal tubular cells. Differentiation is done by an acid fast stain

Answer 14

Severe lead poisoning

Question 15

The urothelium/transitional epithelium is replaced by squamous metaplasia (full
formation of squamous epithelium).
 This epithelium shows excessive keratinisation of cells forming white plaques on
the mucosa.

 There is hyperkeratosis with the presence of anucleated squamous or
hyperkeratotic cells (orangeophilic polygonal shaped cells with no nucleus but a
“ghost” nucleus).

Answer 15

Leukoplakia

Question 16

Ground glass or eosinophilic with a halo

Multinucleation and nuclear moulding

Answer 16

Herpes simplex

Question 17

Well defined cyanophilic, with a halo, “owl-eye”
Nucleus and cytoplasm markedly enlarged
Early inclusions in cytoplasm are multiple, small, cyanophilic

Answer 17

Cytomegalovirus

virus

Question 18

Homogenous glassy, cyanophilic, with a thin halo
Nucleus enlarged, round or oval/cup shaped, single or
binucleated

Answer 18

Polyoma virus

Question 19

Large eosinophilic with a halo, acid fast

Answer 19

Lead poisoning

Question 20

These are non-pathological homogenous glassy transparent threads that can also
be seen in renal disease.

Answer 20

Hyaline casts

Question 21

May result from aggregation of protein in the matrix or from cellular degeneration.
 They have traditionally been classified as finely or coarsely granular.

Answer 21

Granular casts

Question 22

Associated with several renal disorders and are formed by the exfoliation of renal
tubular cells, which form two parallel rows of cells or are scattered throughout the
protein matrix of the cast.

Answer 22

Epithelial casts

Question 23

Casts consisting of leukocytes in a proteinaceous matrix, signal tubulointerstitial
disease as well as transplant rejection.

Answer 23

White blood cell casts

Question 24

Casts are smooth appearing, wide, blunt ended casts with a high refractive
index that indicate chronic renal disease.

Answer 24

Waxy casts

Question 25

Casts contain fat droplets or oval fat bodies due to degeneration of tubular epithelium or the incorporation of lipids into the protein matrix

Answer 25

Fatty casts

Question 26

Renal tubular cells have large eccentric nuclei, fine chromatin, prominent nucleoli, and vacuolated cytoplasm.  They may be single or in clusters, sheets, or tubules.  Lymphocytes may be small plasmacytoid or large immunologically reactive cells.  Other features include increased cellularity with abundant red blood cells, casts, and mixed clusters of epithelial cells and leukocytes.  The specimen also shows evidence of nuclear degeneration and a dirty background.

Answer 26

renal transplant rejection

Question 27

``` Benign tumour Little or no atypia Clusters Papillary structures with palisading cells Honeycomb Many columnar cells Elongated, spindle cells ``` Nuclei and N/C ratio are normal Chromatin is fine and evenly distributed Nuclear rim is smooth and nucleoli are not present. Cytoplasm forms long tail-like processes Background is clean with few RBC

Answer 27

Low grade tumour - Papilloma

Question 28

``` Malignant tumour Slight atypia Clusters Papillae Crowded cells Irregular border ``` Nucleus: Eccentrically Vary in size, shape and staining intensity N/C ratio slightly increased Chromatin: Fine or granular Evenly distributed Mitotic figures rare Nuclear rim has 1 or 2 indentations Nucleoli are small if present Cytoplasm loses it's rim Background is usually clean with RBS

Answer 28

Papillary TCC Grade | I

Question 29

``` Malignant tumour Obvious atypia Isolated cells Small dyscohesive clusters Syncytia Few loose clusters Crowded cells with disarray Irregular outlines Apoptosis ``` Nucleus: Enlarge Pleomorphic Hyperchromatic N/C ratio increased Chromatin: Coarse Irregularly distributed Viable mitotic activity Nuclear rim is irregular ``` Nucleoli: May be prominent, Irregular Cytoplasm: Variable amounts Amphophilic Vacuolated Background: Dirty ```

Answer 29

Papillary TCC Grade | III

Question 30

``` Malignant tumour Isolated cells Clusters Syncytia No papillae Apoptosis ``` Nucleus: Enlarged Hyperchromatic N/C ratio markedly increased Chromatin: Coarse Irregularly distributed Frequent mitotic figures Nuclear rim is irregular Nucleoli: May be prominent Cytoplasm: Scant Background: Clean with RBC

Answer 30

CIS

Question 31

``` Malignant tumour Isolated cells Small aggregates Variable cell size and shape Spindle cells Malignant pearls ``` Nucleus: Hyperchromatic May be pyknotic N/C ratio increased Chromatin: Coarse Irregularly distributed Nuclear rim is smooth to irregular Nucleoli rarely noted ``` Cytoplasm: Dense Eosinophilic or cyanophilic Ectoplasmic rim can be identified ``` Background: Inflammatory and bloody

Answer 31

Well-differentiated SCC

Question 32

``` Malignant tumour May be colonic, colloid, signet ring or clear cell types Small groups Cells align side by side in groups of 3-4 Nuclear polarized to one side. ``` Nucleus: Enlarge Not hyperchromatic Round to oval Eccentrically placed N/C ratio moderately increased Chromatin: Fine Evenly distributed Mitotic figures may be present Nuclear rim is smooth to irregular Nucleoli: Large, prominent, single or multiple red Cytoplasm: Vacuolated Abundant Basophilic Background: Clean

Answer 32

Adenocarcinoma