Urine cytology of primary and secondary urinary bladder adenocarcinoma

BACKGROUND. Primary and secondary adenocarcinomas of the urinary bladder ar e uncommon, and the urine cytology of these tumors has rarely been describe d. Familiarity with the cytomorphology of these neoplasms may facilitate th eir detection in urine cytology specimens. METHODS. The authors reviewed 46 urine samples (19 voided, 19 instrumented, and 8 bladder washings) from 41 patients with biopsy-proven primary urinar y bladder adenocarcinoma (n = 11) or metastatic adenocarcinoma (n = 35) fro m the prostate (n = 17), colon (n = 10), breast (n = 3), kidney (n = 3), or uterus (n = 1), or from unknown origin (n = 1). Cytomorphology, the role o f cytology, and causes for negative diagnoses were evaluated. RESULTS. Cytologic diagnoses of malignancy, adenocarcinoma not otherwise sp ecified, and adenocarcinoma of a specific type were given in 87%, 28%, and 39% of cases, respectively. Columnar cells, coarse chromatin, and necrosis were found in adenocarcinoma of the colon. Syncytial and acinar arrangement s, round or oval nuclei, vesicular chromatin, and prominent nucleoli were c ommonly found in adenocarcinoma of the prostate. These features permitted u s to make a specific diagnosis in 90% of cases of adenocarcinoma of the col on and 41% of cases of adenocarcinoma of the prostate. Cytologic examinatio n failed to lead to a diagnosis of malignancy in 18% of primary adenocarcin oma cases. CONCLUSIONS. A large number of adenocarcinomas of the colon and prostate ha ve sufficient cytologic features to suggest the correct diagnosis in urine samples. The cytomorphology of primary bladder adenocarcinoma is not as eas ily characterized. The submucosal nature of some metastatic deposits and tu mor differentiation influence the diagnostic accuracy. Cancer (Cancer Cytop athol) 1998;84:335-43, (C) 1998 American Cancer Society.