Bladder Wash Cytology: Reactive, Primary or Metastasis?
Elizabeth M. Kurian, MD
Presentation date: July 1, 2015; Expires: July 1, 2018
A 68 year old female with a past medical history of diabetes mellitus II and hypertension presented to the emergency department with complaints of gastrointestinal bleeding. The patient indicated that her urine had been "slowing down" recently. She was experiencing hesitancy and post-void dribbling with a burning sensation upon urination. She denied any prior history of urinary difficulties, urologic surgeries or malignancy. Furthermore, she denied any gross hematuria, fevers, chills, chest pains or shortness of breath. One day prior to her visit, the patient described some limited vomiting. Her labs showed an abnormal creatinine (5.7). The computed-tomographic scan showed bilateral hydronephrosis and bladder wall thickening; therefore the urology service was consulted.
Given the acute renal insufficiency with bilateral ureteral obstruction, the patient was scheduled for cystoscopic placement of bilateral stents to relieve the obstruction. During cystoscopic examination, the urologist observed a small capacity bladder and described the mucosa as erythematous, friable and edematous. There were no obvious papillary tumors. A bladder wash was performed and sent to cytology. Unfortunately, the ureteral orifices could not be identified; therefore the patient was referred to interventional radiology for placement of bilateral percutaneous nephrostomy tubes (PCN). Images of the cytologic bladder wash are shown in Figures 1-4.