Clinical Scenario: Microscopic Hematuria and Atypical Cytology

68-Year-old man with asymptomatic microscopic hematuria, significant tobacco history, negative upper tract imaging, and persistently atypical and suspicious cytology
  • Christopher S. Gomez
  • Mark S. SolowayEmail author
  • Jorge Raul Caso
  • Claudia P. Rojas
  • Merce Jorda


A 68-year-old man who was a former cigarette smoker was found to have atypical/suspicious cells on urinary cytology obtained during a work up for microscopic hematuria. Imaging (presumably a CT urogram) and cystoscopy did not identify an obvious tumor. He has three risk factors for urothelial cancer (UC): male, smoking history, and hematuria. The absence of a cytology that indicates “positive for cancer cells” is most important. Close follow-up by repeat cytology and possibly cystoscopy is reasonable but we would not proceed with bladder or prostatic urethra biopsies, upper tract cytology, ureteroscopy, or submitting the urine for the FISH analysis unless cells consistent with cancer are identified by an experienced cytopathologist. Such investigative procedures for an atypical report would, in our view, subject the patient to potential morbidity with a low likelihood of identifying a UC.


Bladder cancer Urinary cytology Hematuria Cigarette smoking 


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Christopher S. Gomez
    • 1
  • Mark S. Soloway
    • 1
    Email author
  • Jorge Raul Caso
    • 1
  • Claudia P. Rojas
    • 2
  • Merce Jorda
    • 2
  1. 1.Department of UrologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of PathologyUniversity of Miami Miller School of MedicineMiamiUSA

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