NEEDLE ASPIRATION CYTOLOGY OF METASTATIC HIGH-GRADE TRANSITIONAL-CELLCARCINOMAS OF THE URINARY-TRACT

We reviewed 4 cases of high-grade transitional-cell carcinoma (TCC) of the urinary tract with solitary pulmonary metastases that were studie d by transthoracic needle aspiration biopsy cytology. There were two g rade II and two grade III TCCs. The two grade II tumors yielded, in ne edle aspirates, syncytial tumor-cell clusters showing ill-defined, gra nular cytoplasm and slightly pleomorphic nuclei with inconspicuous nuc leoli. In one case the tumor-cell clusters showed a focal acinar arran gement, mimicking cells of an adenocarcinoma. In both cases the electr on microscopy (EM) study of aspirated tumor cells revealed epithelial cells with well-formed cell junctions, intracytoplasmic vesicles, apic al short microvilli, and focal interdigitation of lateral cell membran es, suggesting a urothelial neoplasm. The two grade III TCCs yielded i n needle aspirates, pleomorphic malignant cells singly and in small cl usters, showing well-defined, granular cytoplasm and pleomorphic nucle i containing prominent nucleoli, suggesting a poorly differentiated ad enocarcinoma or an anaplastic large-cell carcinoma. By EM examination the aspirated tumor cells from one case revealed well-formed cell junc tions, intracytoplasmic vesicles, poorly formed microvilli, and focal interdigitation of lateral cell membranes, suggesting a a urothelial d ifferentiation. In the other case the tumor cells were pleomorphic cel ls with occasional cell junctions and no ultrastructural features as s een in the other 3 cases of TCC. The tumor cells from the two grade II TCCs showed strong immunopositive reaction with keratin 7 antibody an d weakly positive reaction with carcinoembryonic antigen antibody (CEA A), while those of the two grade III TCCs displayed only a weak and fo cal immunopositive staining with keratin 7 antibody and strong reactio n with CEEA. (C) 1998 Wiley-Liss, Inc.