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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

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Management of Bladder Cancer

Abstract

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.

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Authors and Affiliations

  1. Department of Urology, University of Miami Miller School of Medicine, 9601 Collins Ave, Apt 1410, Miami, FL, 33154, USA

    Christopher S. Gomez M.D., Mark S. Soloway M.D. & Jorge Raul Caso M.D., M.P.H.

  2. Department of Pathology, University of Miami Miller School of Medicine, 1400 NW 12th Ave, Miami, FL, 33136, USA

    Claudia P. Rojas M.D. & Merce Jorda M.D., Ph.D., M.B.A.

Authors
  1. Christopher S. Gomez M.D.
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  2. Mark S. Soloway M.D.
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  3. Jorge Raul Caso M.D., M.P.H.
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  4. Claudia P. Rojas M.D.
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  5. Merce Jorda M.D., Ph.D., M.B.A.
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Corresponding author

Correspondence to Mark S. Soloway M.D. .

Editor information

Editors and Affiliations

  1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA

    Badrinath R. Konety

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

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Gomez, C.S., Soloway, M.S., Caso, J.R., Rojas, C.P., Jorda, M. (2015). Clinical Scenario: Microscopic Hematuria and Atypical Cytology. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_12

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  • DOI: https://doi.org/10.1007/978-1-4939-1881-2_12

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  • Online ISBN: 978-1-4939-1881-2

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