Urinary Cytology & FISH
Below you find the 52 cases of the quiz.
The online quiz has been answered by 246 specialists around the world in April 2005.

You may directly jump to the solutions.


Case 1
Bladder wash. 86 year-old woman.
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What is your diagnosis for case 1? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 2
Voided urine. 52 year-old man.

What is your diagnosis for case 2 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 3
Bladder wash. Follow-up cystoscopy for recurrent carcinoma in situ and high-grade papillary urothelial tumor (pTa G3).
65 year-old woman.

What is your diagnosis for case 3 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 4
Bladder wash. Follow-up cystoscopy for recurrent high-grade papillary urothelial tumors (pTa G3 and pT1 G3) and carcinoma in situ.
80 year-old man.

What is your diagnosis for case 4 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 5
Bladder wash. Follow-up cystoscopy after treatment for low-grade papillary urothelial tumor (pTa G2).
58 year-old man.

What is your diagnosis for case 5 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 6
Bladder wash. Follow-up cystoscopy after treatment for high-grade papillary urothelial tumor (pT1 G3).
80 year-old man.

What is your diagnosis for case 6 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 7
Bladder wash. Follow-up cystoscopy after treatment for papillary neoplasm of low malignant potential (pTa G1).
73 year-old man.

What is your diagnosis for case 7 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 8
Bladder wash. 51 year-old man.

What is your diagnosis for case 8 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 9
Bladder wash. Diffuse redness of the bladder mucosa and papillomatous lesion. 71 year-old man.

What is your diagnosis for case 9 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 10
Ureteral wash. History of phenacetin (analgesic) abuse and family history of cancer of the renal pelvis. 73 year-old woman.

What is your diagnosis for case 10 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 11
Bladder wash. Follow-up cystoscopy after treatment for carcinoma in situ and high-grade papillary urothelial tumor (pT1b G3).
58 year-old man.

What is your diagnosis for case 11 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 12
Bladder wash. Follow-up cystoscopy for recurrent low-grade and high-grade papillary urothelial tumors (pT1 G3 and pTa G2).
76 year-old man.

What is your diagnosis for case 12 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 13
Bladder wash. Follow-up cystoscopy after treatment for high-grade papillary urothelial tumor (pT1 G3) and carcinoma in situ.
BCG instillations 37, 25, and 8 months ago. 68 year-old man.

What is your diagnosis for case 13 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 14
Ureteral wash. Right ureter and renal pelvis with thickened wall. 74 year-old woman.

What is your diagnosis for case 14 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 15
Bladder wash. Follow-up cystoscopy after treatment for low-grade papillary urothelial tumor (pTa G1).
77 year-old woman.

What is your diagnosis for case 15 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 16
Bladder wash. 61 year-old man.

What is your diagnosis for case 16 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 17
Bladder wash. History of hematuria. 58 year-old man.

What is your diagnosis for case 17 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 18
Bladder wash. Follow-up cystoscopy after treatment for high-grade papillary urothelial tumor (pTa G2-3).
67 year-old woman.

What is your diagnosis for case 18 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 19
Bladder wash. Follow-up cystoscopy after treatment for low-grade papillary urothelial tumor (pTa G1-2).
48 year-old woman.

What is your diagnosis for case 19 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 20
Bladder wash. Episodes of recurrent macrohematuria. 72 year-old man.
What is your diagnosis for case 20 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 21
Renal pelvic wash. History of macrohematuria. 57 year-old woman.

What is your diagnosis for case 21 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 22
Bladder wash. Recurrent microhematuria for years. Chemotherapy for breast cancer. 63 year-old woman.

What is your diagnosis for case 22 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 23
Bladder wash. 85 year-old man.

What is your diagnosis for case 23 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 24
Renal pelvic wash. Recurrent cystitis and moderate celllular atypia in a previous bladder wash. 39 year-old woman.

What is your diagnosis for case 24 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 25
Bladder wash. 66 year-old man.

What is your diagnosis for case 25 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 26
Bladder wash. Macrohematuria. 82 year-old woman.

What is your diagnosis for case 26 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 27
Voided urine. Analgesic nephropathy. Follow-up after treatment for recurrent papillary neoplasms
of low malignant potential (pTa G1). 63 year-old man.

What is your diagnosis for case 27 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 28
Bladder wash. Bladder diverticulum. Prostatic hyperplasia. 63 year-old man.

What is your diagnosis for case 28 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 29
Renal pelvic wash. Follow-up after treatment for recurrent low grade papillary urothelial tumors (2x pTa, G1; 1x pTa, G2). 55 year-old man.

What is your diagnosis for case 29 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 30
Bladder wash. Microhematuria and voiding difficulties. 67 year-old woman.

What is your diagnosis for case 30 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 31
Voided urine. 75 year-old man.

What is your diagnosis for case 31 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 32
Bladder wash. Nephroureterectomy for the treatment of multiple papillary urothelial tumors (pTa G2-3) one year ago.
Follow-up cystoscopy. 59 year-old man.

What is your diagnosis for case 32 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 33
Voided urine. 63 year-old man.

What is your diagnosis for case 33 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 34
Bladder wash. Diabetic nephropathy. Benign prostatic hyperplasia. 61 year-old man.

What is your diagnosis for case 34 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 35
Voided urine. History of macrohematuria. 50 year-old man.

What is your diagnosis for case 35 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 36
Bladder wash. Follow-up cystoscopy after treatment for recurrent low-grade papillary urothelial tumors (pTa G1 and pTa G2).
72 year-old man.

What is your diagnosis for case 36 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 37
Bladder wash. Irregular mucosa. 75 year-old woman.

What is your diagnosis for case 37 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 38
Bladder wash. Tumor of the left renal pelvis. 41 year-old woman.

What is your diagnosis for case 38 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 39
Bladder wash. Hematuria. 71 year-old man.

What is your diagnosis for case 39 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 40
Bladder wash. Follow-up cystoscopy after treatment for high grade papillary urothelial carcinoma (pT1 G3).
BCG treatment 10 months ago. 81 year-old woman.

What is your diagnosis for case 40 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 41
Bladder wash. Chronic microhematuria. 55 year-old woman.

What is your diagnosis for case 41 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 42
Bladder wash. Persistent microhematuria. 46 year-old man.

What is your diagnosis for case 42 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 43
Bladder wash. Breast and ovarian cancer. 46 year-old woman.

What is your diagnosis for case 43 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 44
Bladder wash. Five weeks after initiation of BCG treatment for carcinoma in situ of the bladder.
63 year-old man.

What is your diagnosis for case 44 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 45
Bladder wash. Follow-up cystoscopy 9 months after treatment for carcinoma in situ of the bladder with BCG instillations.
67 year-old man.

What is your diagnosis for case 45 (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 46
Voided urine. 22 year-old woman.

What is your diagnosis for case 46? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 47
Bladder wash. Follow-up cystoscopy after treatment for recurrent papillary neoplasms of low malignant potential (pTa G1).
72 year-old man.

What is your diagnosis for case 47? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 48
Renal pelvic wash. Follow-up after treatment for papillary neoplasm of low malignant potential (pTa G1).
88 year-old man.

What is your diagnosis for case 48? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 49
Bladder wash. Follow-up cystoscopy after treatment for low grade papillary urothelial tumor (pTa G2).
48 year-old woman.

What is your diagnosis for case 49? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 50
Bladder wash. Follow-up cystoscopy after treatment for papillary neoplasm of low malignant potential (pTa G1).
74 year-old man.

What is your diagnosis for case 50? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 51
Bladder wash. Tetraplegic patient with indwelling catheter. Sonographic detection of papillary structures in the trigonum.
41 year-old woman.

What is your diagnosis for case 51? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive

Case 52
Bladder wash. Chronic hematuria. 73 year-old patient.

What is your diagnosis for case 52? (required)
 1 Negative, benign
 2 Reactive changes
 3 Mild atypia, cannot exclude low grade neoplasia
 4 Moderate atypia, suspicious
 5 Severe atypia, positive
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