Normal urothelial cells have bland nuclear chromatin, uniformly round nuclei, inconspicuous nucleoli, and frothy cytoplasm. Reactive/inflammatory changes in urothelial cells are similar to those of all epithelial cells, i.e., accentuated nucleoli, slightly coarsened chromatin, round nuclei and a variably increased nuclear-cytoplasmic (NC) ratio (Figs. 2.12-2.14, 2.16-2.19). In contrast, cells from low grade urothelial carcinoma have oval nuclei, indiscernible nucleoli, and high NC ratios (Figs. 3.7-3.19)
Most infectious agents are not obvious in voided urine or washings, but occasionally trichomonads, evidence of polyoma virus (decoy cells) (Figs. 2.20, 2.21), Herpes simplex virus
(Figs. 2.22, 2.23), cytomegalovirus (CMV) (Fig. 2.24) or human papillomavirus (koilocytes) is seen (Figs. 2.25). Schistoma ova are found rarely in our practice, but should be sought when extensive squamous metaplasia is seen.
Renal tubular epithelial cells are usually so degenerated by the time they reach the bladder that they resemble histiocytes (Fig. 2.26). They are usually few in number, unless there is intrinsic renal disease affecting the tubules. Cellular casts preserve the cyto-morphology of these cells (Fig. 2.27), and are important to report.
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