4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

Clinical Cytology - Posters
THE ROLE OF CYTOLOGY IN THE DIAGNOSIS OF PYELON TUMOUR - A CASE REPORT
Ezgeta Karačić D1 , Valetić J2 , Zeljko Ž3 , Vidas Ž3 , Jelić-Puškarić B4 ,
Sabljar-Matovinović M5 , Kardum-Skelin I4 1 Vukovar General Hospital, Department of Cytology, Vukovar, Croatia
2 University Hospital Merkur, Department of Gynaecology & Obstetrics, Zagreb, Croatia
3 University Hospital Merkur, Division of Urology, Zagreb, Croatia
4University Hospital Merkur, Department of Medicine, Laboratory for Cytology and Hematology,
Zagreb, Croatia
5 University Hospital Merkur, Department of Medicine, Zagreb, Croatia
Tumours of the renal pelvis and ureter arising from epithelial and mesenchymal elements
account for 8% of all urinary tract neoplasms and of these greater than 90%
are urothelial carcinomas. Haematuria and lumbal pain are the major symptoms. In a
72-year-old woman hospitalized for acute myocardial infarction, mediastinal lymphadenopathy
is detected incidentally as well as a left supraclavicular lymph node, approximately
1.5 cm in diameter, from which samples were taken for cytological analysis. The
smears revealed a number of single, very large cells, with distinct anisonucleosis and
eccentric nuclei, often with large nucleoli and tiny granules in a prominent cytoplasm.
Immunocytochemical staining showed positivity for CK18, 20 and 7 and negativity for vimentin,
HMB45, AFP, thyreoglobulin, synaptophysin and chromogranin. The findings indicate
malignant epithelial cells, most probably of the transitional cell epithelium. Urine
sediment analysis of 3 samples discovered cells identical to those found in the lymph
node sample. Further diagnostic tests (abdominal ultrasound, MR, PET-CT, cystoscopy)
confirmed the presence of a tumour in the pyelon of the right kidney, which had caused
an obstruction and atrophy of the right kidney. The patient started to receive chemotherapy,
however metastases have been detected (by scintigraphy and PET-CT) in the skelet
and a lymph nodes. This work confirms the clinically valuable role of cytology (exfoliative
and FNA) in the diagnosis of rare occurrences and localizations of malignant tumours.
In this case, cytology detected the presence of malignant cells in the lymph node and in
the urine much before the onset of clinical signs of the disease before other diagnostic
methods.
draz_ezgeta@hotmail.com
119
4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology