Definition/General
Introduction:
Inflammatory changes in urine cytology represent non-neoplastic cellular alterations due to various inflammatory conditions
These changes are commonly seen in urinary tract infections
They can mimic dysplastic or malignant changes
Proper recognition is crucial for accurate cytological interpretation.
Origin:
Inflammatory changes originate from the urothelial lining in response to various stimuli
Common causes include bacterial infections
Viral infections
Chemical irritants
Physical trauma
Immunological reactions
The changes represent reactive rather than neoplastic processes.
Classification:
Classified based on underlying etiology
Infectious inflammatory changes (bacterial, viral, fungal, parasitic)
Non-infectious inflammatory changes (chemical, radiation, mechanical)
Acute inflammatory changes (recent onset)
Chronic inflammatory changes (long-standing).
Epidemiology:
Common finding in routine urine cytology
More frequent in females due to shorter urethra
Peak incidence in reproductive age group
Associated with urinary tract infections
Higher prevalence in diabetic patients
Common in catheterized patients
Increased frequency with immunocompromised states.
Clinical Features
Presentation:
Dysuria (burning sensation during urination)
Frequency and urgency of urination
Suprapubic pain or discomfort
Hematuria (microscopic or gross)
Cloudy urine with strong odor
Pelvic pain in females
Lower back pain may be present.
Symptoms:
Urinary symptoms (frequency, urgency, dysuria)
Systemic symptoms (fever, chills)
Pelvic pressure sensation
Nocturia (increased nighttime urination)
Incomplete bladder emptying sensation
Pain during sexual intercourse
Fatigue and malaise.
Risk Factors:
Female gender (shorter urethra)
Sexual activity
Poor hygiene practices
Diabetes mellitus
Immunocompromised states
Urinary catheterization
Pregnancy
Urinary tract abnormalities
History of recurrent UTIs.
Screening:
Routine urinalysis with microscopy
Urine culture and sensitivity
Midstream clean-catch urine collection
Catheter-collected samples when indicated
Suprapubic aspiration in specific cases
Follow-up cytology after treatment.
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Gross Description
Appearance:
Turbid or cloudy urine specimen
May show purulent appearance
Color varies from pale yellow to amber
Strong ammonia-like odor may be present
Sediment visible on standing
Blood may be present (pink to red tinge).
Characteristics:
Increased cellularity of the specimen
Presence of inflammatory debris
Bacterial organisms may be visible
Mucus strands present
Crystal formations possible
Protein-rich appearance with foam.
Microscopic Description
Immunohistochemistry
Positive Markers:
CK7 and CK20 (urothelial origin)
Uroplakin (umbrella cells)
p53 (reactive, not mutant pattern)
Ki-67 (increased proliferation)
CK5/6 (basal cells)
Thrombomodulin (normal urothelium).
Negative Markers:
p16 (usually negative in reactive changes)
High-risk HPV markers (negative)
CEA (usually negative)
CA 19-9 (negative)
TTF-1 (negative)
PSA (negative in males).
Diagnostic Utility:
Limited role in inflammatory changes diagnosis
p53 shows wild-type pattern (not overexpressed)
Ki-67 may be elevated but non-specific
Useful to exclude malignancy
CK7/CK20 confirm urothelial origin
Markers help differentiate from metastases.
Molecular/Genetic
Differential Diagnosis
Similar Entities:
Low-grade urothelial dysplasia
High-grade urothelial carcinoma
Viral cytopathic effects
Radiation cystitis
Drug-induced changes
Reactive atypia from instrumentation.
Distinguishing Features:
Inflammatory changes: Polymorphous population
Clinical correlation with infection
Dysplasia: Monotonous population, higher N:C ratio
Carcinoma: Marked pleomorphism, irregular chromatin
Viral effects: Specific inclusion bodies
Radiation: Bizarre giant cells.
Diagnostic Challenges:
Distinguishing reactive atypia from dysplasia
Severe inflammation may obscure architecture
Polyomavirus changes mimic malignancy
Instrumentation effects cause reactive changes
Chronic inflammation may show marked atypia.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Urine specimen, [collection method], [volume] ml
Specimen Adequacy
Adequate for cytological evaluation with [cellularity level]
Background
[degree] inflammatory background with [inflammatory cell types]
Cellular Findings
Reactive urothelial cells with [specific features]. No malignant cells identified.
Organisms
[present/absent]. If present: [type and morphology]
Diagnosis
Inflammatory changes, [specify type if known]
Clinical Correlation
Correlate with clinical findings and urine culture results
Recommendations
Follow-up cytology after treatment. [Additional recommendations]