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Additional info for Urinary Cytology: Manual and Atlas

Example text

The urothelium is a highly specialized mucosa functioning as a barrier between the urine and interstitium and as the lining for a hollow organ that undergoes substantial fluctuations in its volume and wall tension. Normal cell turnover in the urothelium is slow, occurring on the order of 200 days. After injury, however, the urothelium can proliferate very rapidly. Samma et al. (1987) showed that rat bladders denuded of urothelium by detergents underwent complete reepithelialization within a few days.

The process apparently is still reversible at this stage. Later the uppermost cell layer loses its regular surface structure, cellular interactions are impaired, and cytologic changes become apparent At this stage the proliferation continues to progress even if the carcinogen is withdrawn. Another clinically important observation is that bladder carcinogens are not urothelium-specific, but can induce adenocarcinoma even in bowel segments into which urinary discharge has been diverted. This underscores the need for a careful endoscopic and cytologic examination in patients who have undergone cystectomy with bladder reconstruction or urinary diversion into the open bowel.

1975). - Cyclophosphamide induces a symptomatic or asymptomatic chemical cystitis that is associated with an increased risk of bladder cancer (Pearson and Soloway 1978; Fairchild et al. 1979). Since the introduction of cystitis prophylaxis by Mesna, the risk of bladder cancer may have become negligible. Even so, it is prudent to schedule regular urinary cytologic examinations in patients who have received prolonged treatment with cyclophosphamide. Duncan et al. (1977) noted an increased incidence of bladder tumors in patients who received pelvic radiation for gynecologic tumors.

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