1989 Volume 80 Issue 4 Pages 545-554
Giant sections were prepared from 31 totally removed bladders because of transitional cell carcinoma and examined for accompanied urothelial dysplasia. Preoperatory urinary cytology related to dysplasia was also investigated.
Dysplasia of the urinary bladder was morphologically defined as the urothelium with intermediate atypism between normal transitional epithelium and carcinoma in situ (CIS) of grade 3 anaplasia. Dysplasia was divided into four groups from two points of view: slight and severe dysplasia on the basis of cellular anaplasia, epithelial stratification and cellular polarity, and clear cell and compact cell dysplasia on the basis of features of dysplastic cell cytoplasm.
Compact cell slight dysplasia was recognized in all specimens examined. Compact cell severe dysplasia as well as CIS was frequently accompanied with high grade papillary and non-papillary cancers, but not with low grade papillary cancer. Both slight and severe clear cell dysplasia tended to be frequently associated with high grade cancer. Because of no distinctiveness in nuclear atypia from CIS, severe dysplasia could be regarded as so called CIS of grade 2 anaplasia.
From the current results, it appears likely that severe dysplasia is related to the occurrence of high grade bladder cancer. In addition, dysplastic cells exfoliated in to urine retained features of each type of original dysplasia, which were identified with a more than 70% accuracy. The result indicates that urinary cytology offers histologic aspects of coexisting dysplasia as well as bladder cancer.