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. 2012 Jan;29(1):41-4.
doi: 10.4103/0970-9371.93220.

Urothelial cells in smears from cervix uteri

Luis Alberto Palaoro  1 , Fernando Guerra, Anabela Angeleri, Marta Palamas, Sardi-Segovia Melba, Adriana Esther Rocher
Affiliations

Urothelial cells in smears from cervix uteri

Luis Alberto Palaoro et al. J Cytol. 2012 Jan.

Abstract

Objectives: To establish the cytological criteria to identify the urothelial cells in cervical smears in order to avoid mistakes in the cytological diagnosis.

Materials and methods: Cervical smears from 34 post menopausal women with vesicovaginal fistulas, advanced bladder prolapse and genital erosive lichen planes (vulvar kraurosis) (Group 1) and transitional cell metaplasia of the cervix (TCM, Group 2) were stained with Papanicolaou technique. The cervical samples were taken during the routine annual examination for prevention of the uterine cancer.

Results: The smears of cervix from Group 1 showed urothelial cells from the three layers of the transitional epithelium. The umbrella cells are the bigger ones with relatively large nuclei. Frequently, they are multinucleated with single or multiple nucleoli and a typical "frothy" cytoplasm (cytoplasmic vacuoles). The cells of the Group 2 showed nuclei with oval to spindled shapes, some tapered ends, less cytoplasm than squamous metaplastic cells, powdery chromatin, small nucleoli and nuclear grooves.

Conclusions: The umbrella cells may be mistaken for dysplastic cells originating in low grade squamous intraepithelial lesions lesions (LSILs) due to their nuclear and cytoplasm sizes. Therefore, it is important to know the possibility of their appearance in the cervical smears, especially in post menopausal patients in order to avoid a false diagnosis of an intraepithelial lesion. It is unlikely that deeper cells of urothelium would be confused with high grade squamous intraepithelial lesion (HSIL) cells. However, their presence might be a reason of mistake in the diagnosis. TCM is an under-recognized metaplastic phenomenon of the cervix and vagina, which is a mimicker of high-grade squamous intraepithelial lesion. The differential characteristic between umbrella cells, cells from TCM and the deeper urothelial cells, and LSIL and HSIL are detailed in the present paper.

Keywords: Bladder prolapsed; koilocytes; low grade squamous intraepithelial lesions; transitional cell metaplasia; umbrella cells; urothelium; vesicovaginal fistulas.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) A multinucleated umbrella cell (top) and some squamous epithelial cells (bottom). Exocervical smear (Pap, ×400). (b) A multinucleated umbrella cell (centre, bottom). At the right, a cluster of deep cells from transitional epithelium. Exocervical smear (Pap, ×400). (c) Umbrella cells (one of them multinucleated) showing the typical frothy cytoplasm. Exocervical smear (Pap, ×400). (d) Cluster of deep urothelial cells. Exocervical smear (Pap, ×400)
Figure 2
Figure 2
(a) Cells infected by HPV. Three koilocytes are clearly visible, with viral nuclei and classic hallos. Exocervical smear (Pap, ×400). (b) Big cell exfoliated form LSIL. This cell is called “CIN 1 cell”: Note the granular, homogeneous and hyperchromatic chromatin. Exocervical smear (Pap, ×400)
Figure 3
Figure 3
Cells from transitional metaplasia of the cervix uteri. Note the characteristic grooves. Exocervical smear (Pap, ×1500)
Figure 4
Figure 4
Cells exfoliated form HSIL. Exocervical smear (Pap, ×400)
See this image and copyright information in PMC

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