The morphologic features are consistent with adenocarcinoma, not squamous cell carcinoma. The cellular and group contours are round. Features of squamous cell carcinoma, e.g., keratinization and necrosis, are not present. The background is clean.
These cells easily may be confused with endometrial cells; however, they do not have features of benign endometrial cells and should at least be categorized as atypical.
High-grade squamous intraepithelial lesion (HSIL) is in the differential diagnosis; however, under careful inspection, one should notice that these atypical cells have vesicular nuclei and prominent nucleoli, and these are not features of HSIL.
These atypical cells represent metastatic mammary carcinoma. They have high nuclear to cytoplasmic ratios, and a “cell-in-cell” and short single file arrangement are evident in the urine sample (photo on right). An intracytoplasmic vacuole within which is a condensation of mucus is also present. These features and the small size of the cells are highly suggestive of mammary lobular carcinoma.
Urothelial carcinoma cells that shed into urine appear as isolated cells or in small, three-dimensional clusters. Single file formation and intracytoplasmic vacuoles are not typical features of urothelial carcinoma.