American Urological Association - High Grade TCC/ CIS
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High Grade TCC/ CIS

Image A

Image B

  • Cytology is most useful for detecting flat CIS, which may be difficult to identify grossly.
  • Cytologic features:
    • Neoplastic cells usually exfoliate in large numbers and are poorly cohesive (shed singly or in small clusters).
    • High N:C ratio.
    • Nuclei are large, hyperchromatic, pleomorphic, with prominent red nucleoli (image A).
    • Chromatin is coarsely clumped.
    • Distinction between CIS and invasive TCC is tricky, but as a rule of thumb, the presence of necrotic debris (cell parts and lots of neutrophils) favors invasion (image B); CIS typically has a much cleaner background.