{"id":45130,"date":"2025-08-05T14:04:54","date_gmt":"2025-08-05T06:04:54","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=45130"},"modified":"2025-08-05T16:58:08","modified_gmt":"2025-08-05T08:58:08","slug":"urine-1","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/urine-1\/","title":{"rendered":"Mystery cases &#8211; Urine 1"},"content":{"rendered":"\n<h2>\n\t\tURINE 1\n\t<\/h2>\n\t<h1>Odd cells in the urine<\/h1>\n\t<p><strong>Clinical history<\/strong>: Ileal conduit urine specimen from a 64-year old female with a history of invasive urothelial carcinoma, post cystectomy and urinary diversion procedure. What is the diagnosis? What is the structure circled in red?<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine1.png\" alt=\"Urine case 1\" itemprop=\"image\" height=\"584\" width=\"768\" title=\"urine1\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine2.png\" alt=\"urine2\" itemprop=\"image\" height=\"581\" width=\"768\" title=\"urine2\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine3.png\" alt=\"urine3\" itemprop=\"image\" height=\"581\" width=\"768\" title=\"urine3\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li aria-level=\"1\">Normal features of urinary diversion (ileal conduit) urine specimens\u00a0\n<ul>\n<li aria-level=\"2\">Cellular smears showing intestinal epithelium, which exfoliates more generously than urothelium.\u00a0<\/li>\n<li aria-level=\"2\">Intestinal epithelial cells\n<ul>\n<li aria-level=\"3\">Acquire small rounded contours<\/li>\n<li aria-level=\"3\">Show degenerative changes, and may have a histiocytoid appearance<\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"2\">Background may be &#8216;dirty&#8221;\n<ul>\n<li aria-level=\"3\">Variable inflammatory cells<\/li>\n<li aria-level=\"3\">Amorphous debris and bacteria\u00a0<\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"2\">Gastrointestinal mucus and faecal material should\u00a0not\u00a0be present. Presence of these elements are suggestive of an entero-urinary fistula.\u00a0<\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"1\">Unusual components in this specimen\n<ul>\n<li aria-level=\"2\">Mucin-like material\u00a0\n<ul>\n<li aria-level=\"3\">Purple\/bright blue on Pap stain<\/li>\n<li aria-level=\"3\">Fibrillary edges<\/li>\n<li aria-level=\"3\">Central striations<\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"2\">Large, plant-like cells\n<ul>\n<li aria-level=\"3\">Elongated to polygonal cells occurring in isolation, small aggregates or larger clusters forming &#8216;plant cell-like&#8217; structures\u00a0<\/li>\n<li aria-level=\"3\">Thick, rigid and waxy cell borders<\/li>\n<li aria-level=\"3\">Densely-staining central, reddish\/deep orange core<\/li>\n<li aria-level=\"3\">Pericentral granular basophilic material in some cells<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Discussion<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine4.png\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine5.png\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li aria-level=\"1\">Discussion:\u00a0\n<ul>\n<li aria-level=\"2\">Vegetable\/plant cell-like structures have been reported in urinary bladder diversion cytology specimens [1-3]<\/li>\n<li aria-level=\"2\">They are likely to be contaminant from the adhesive or skin barrier of urostomy care products, which contain guar gum, a hydrocolloid which is of vegetable origin [2]<\/li>\n<li aria-level=\"2\">In most cases, these vegetable cell-like structures were admixed with lubricant jelly [1]<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine6.png\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/urine7.png\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li aria-level=\"1\">Differential diagnoses:\u00a0\n<ul>\n<li aria-level=\"2\">Faecaluria indicating a fistula between urinary and intestinal tract\n<ul>\n<li aria-level=\"3\">Cellular heterogeneity e.g. presence of degenerate striated muscle from ingested meat in addition to vegetable matter would favour faecaluria\u00a0<\/li>\n<li aria-level=\"3\">Plant cells from ingested vegetable material may also show degenerative features<\/li>\n<li aria-level=\"3\">Clinical corroboration should be sought, e.g. infective symptoms, pneumaturia, faecal material in urostomy bag, suggestive imaging findings<\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"2\">Parasitic ova (e.g. schistosomiasis)\u00a0<\/li>\n<li aria-level=\"2\">Thick waxy appearance may mimic viral inclusions (e.g. Molluscum bodies)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<em>[1] Quiroga-Garza G, Nassar D, Khalbuss W, E, Monaco S, E, Pantanowitz L. Vegetable Cell Contaminants in Urinary Bladder Diversion Cytology Specimens. Acta Cytologica 2012;56:271-6.<br \/>\n<\/em><em>[2] Planin\u0161ek T, Kladnik A, Pohar-Marin\u0161ek Z, Fle\u017ear MS. Vegetable cells in urinary samples of patients with bricker ileal conduit. Diagn Cytopathol 2014;42(2):120-4.<br \/>\n<\/em><em>[3] Yamashita M, Hotta M, Yoshino K, Hidaka Y, Kimura T. A Food Debris-Like Component in the Urine Sediment From a Urostomy Pouch. Lab Med 2017;48(2):178-82.<\/em>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li aria-level=\"1\">Urine, bladder diversion (ileal conduit) cytology specimen:\n<ul>\n<li aria-level=\"1\"><strong>No malignant cells seen; Vegetable cell contaminant from urostomy bag adhesive<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\t<p><em>Case writer: Dr Ooi Li Yin\u00a0<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>URINE 1 Odd cells in the urine Clinical history: Ileal conduit urine specimen from a 64-year old female with a history of invasive urothelial carcinoma, post cystectomy and urinary diversion procedure. What is the diagnosis? What is the structure circled in red? Cytologic findings Expand &nbsp; Normal features of urinary diversion (ileal conduit) urine specimens\u00a0 [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-45130","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/urine-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"URINE 1 Odd cells in the urine Clinical history: Ileal conduit urine specimen from a 64-year old female with a history of invasive urothelial carcinoma, post cystectomy and urinary diversion procedure. 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