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Hi Dr Shah - I'm an Anatomical Path Registrar in my first year of training and I just wanted to thank you for your excellent lectures - they have helped me develop my knowledge of genitourinary pathology so much. You are an incredibly gifted teacher.

Very good presentation, clearly explaining all key points

Thank you sir for the excellent presentation. Can low grade urothelial carcinomas be lamina propria invasive ? Should one be very cautious signing this out as its rare?

Excellent slide presentation Dr. Shah. Is it still true today that the predictive value of HGPIN has declined significantly now 6 years after this video?

Thank you for great lecture! Unfortunately cannot see the complete tables bc of your lecture box in the lower right corner😭

This series has to continue and increase in frequency. Very helpful!

i would nominate you for the nobel prize if i could. Wonderful presentation!

I feel this talk is incorrectly titled as for "...dummies" which is misleading. I suggest it be changed to incorporate the characterization that it is for inquiring minds.

Thank you very much

Everytime the picture changes, I get a jump scare because of the sudden spike in your voice volume! XD Nontheless a very informative lecture doctor, thank you very much!

excellent. thanks Dr. Shah.

Hello sir may I know how many percentage of clear cell carcinoma can express AMACR

Thank you very much for this fantastic and illustrative lecture ❤

Great explanation of some of the confusing concepts of the updated Gleason grading. Thank you Dr. Shah.

Excellent lecture with very practical teaching points. Thank you Dr. Shah.

Excellent lecture ! Thanks sir

Excellent! It can't be made more succinct. Hope more of these are made available.

I have been diagnosed with intraductal carcinoma and researching this form of prostate cancer. Thank you for your instruction.

Thank you very much for the excellent lecture.

Fantastic presentation!

Fantastic presentation! Please keep this format going, it's a valuable contribution to GU pathology education!!

My husband has Gleason 7 3+4 Criboform 4. One surgeon wanted to take it out, and another wants to radiate. With criboform in your opinion what is the best way

what is the name of your book sir

Thank you ! What would the IHC be in a Hybrid Oncocytic Tumour please..?

please keep the interactive and free discussion format

loved the interactive format.

What about chronic prostatitis it can mimic cancer too how common is it?

Great presentation! Should we perform FH immunostaining even if it shows 100% tubulocystic morphology?

Thank you for your effort This was so informative!

This lecture is more helpful than any other resources Thank you so much sir!

Wonderful presentation sir, thanks for clearing the concept

need a diagram for cell spaces of the urinary bladder?

Explained in a nice and simple way. Very helpful lecture. Thank you sir.

What is the best treatment for metastatic Tubulocystic RCC? Thank you!

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Transcript: " We will discuss the diagnostic criteria in each category in detail. First, we will discuss adequacy in urinary cytology. The following conditions meet the criteria for “Unsatisfactory for Evaluation”: •Acellular or virtually acellular sample •Less than 10 urothelial cells for a voided urine or less than 15 cells for an instrumented urine •Presence of only keratinizing squamous cells •Specimen contains >75% obscuring debris, inflammation, or lubricant •Presence of any atypical or malignant cells is adequate for evaluation. •For voided urine: >30 ml, contains any urothelial cells; for instrumented urine: ≥2 urothelial cells/HPF or ≥200 cells. NHGUC: negative for high-grade urothelial carcinoma. This includes a variety of situations that previously could be in the “Atypical” category. It includes benign urothelial, glandular, and squamous cells; fragments; clusters; changes with urolithiasis; viral cytopathic effect; post-therapy effects; diversion urine, etc. It is important to know this category well, as some are close mimickers of atypical urothelial cells. We will discuss this category in detail. Umbrella cells can be mono-, bi-, or multi-nucleated. Cytoplasm is dense or vacuolated. Cell membrane is sharply demarcated, generally with one flat edge. Multi-nucleation is called “endomitosis” and is caused by nuclear division without cytoplasmic division. Some umbrella cells can be smaller with degenerated (pyknotic) nuclei and mimic atypical cells. Glandular cells can be columnar or cuboidal, generally seen in instrumented urine. They may be derived from cystitis cystica or glandularis or the female genital tract. Renal tubular cells are small, generally poorly preserved with pyknotic, dark, eccentric nuclei and granular cytoplasm. They are easier to recognize when they form small clusters or casts. Seminal vesicle cells have enlarged, hyperchromatic nuclei. High N/C ratio can also have prominent nucleoli, mimicking high-grade urothelial cells. Presence of yellow-brown cytoplasmic lipofuscin pigment and sperm in the urine specimen are important clues for identification. They can also cause abnormal DNA ploidy measurement. Intermediate and basal cells often discriminate in clusters with stones, infection, or procedures. Cell clusters with urolithiasis can be 2-3D, spherical, with smooth cytoplasmic contours. Intermediate cell clusters may have a feathery appearance at the periphery. These clusters can be abundant in instrumented urine but can also be present in voided urine. When the clusters show no obvious cytological atypia and no fibrovascular core, they are considered “pseudo-papillae” and should be classified as NHGUC, but a comment could be added that LGUN cannot be ruled out without clinical correlation, as urine cytology has low sensitivity for detecting LGUN. Polyomavirus: The typical findings have been described as “decoy cells,” “comet cells,” or “net cells” with large homogeneous opaque or ground glass intranuclear inclusions. However, in different stages of infection, the cytopathological features may not be typical. When viral particles leach out, chromatin may be coarse, mimicking HGUC; atypical diagnosis may be rendered. BCG, mitomycin, and thiotepa may be intravesically administered. They cause inflammatory response, producing sloughing and degeneration of both benign and neoplastic urothelium. Mitomycin and thiotepa can cause nuclear enlargement, hyperchromasia, smudgy chromatin, and degenerated or vacuolated cytoplasm. Most have a low N/C ratio. When they have a high N/C ratio, they closely mimic HGUC. Systemically administered drugs like cyclophosphamide and busulfan may also cause marked cellular abnormalities. Radiation effects are characterized by cytomegaly with nuclear enlargement, multinucleation, and abundant vacuolated cytoplasm, maintaining a low N/C ratio. Next is AUC: Atypical Urothelial Cells. Diagnostic criteria are: • Non-superficial, non-degenerated cells with increased N/C ratio >0.5 • Plus one of the following nuclear features: › Nuclear hyperchromasia, OR › Irregular, clumpy chromatin, OR › Irregular nuclear membrane, OR More pictures of AUC. They also have increased N/C ratio. Some clusters show irregular nuclear membrane. Some show nuclear hyperchromasia. Some show irregular, clumpy chromatin. Next is HGUC: High-Grade Urothelial Carcinoma. Diagnostic criteria include: • N/C ratio >0.7 • Moderate to severe nuclear hyperchromasia • Irregular nuclear membrane • Coarse, clumped chromatin • Quantity also matters here; needs at least 5-10 abnormal cells for HGUC. Other notable cytomorphological features include cellular pleomorphism, prominent nucleoli, mitoses, necrosis, etc. Urinary cytology has high sensitivity and specificity in detecting both high-grade papillary urothelial carcinoma and CIS. Next is SHGUC: Suspicious for High-Grade Urothelial Carcinoma. Diagnostic criteria include: • Increased N/C ratio and hyperchromasia • Plus one of the following: › Irregular, clumpy chromatin › Irregular nuclear membranes For N/C ratio, the TPS book uses 0.5-0.7, which is similar to AUC category. However, recent lectures from Dr. Wojcik and Dr. Barkan use N/C ratio >0.7, which is close to HGUC category. I hope TPS 2.0 can better clarify this discrepancy. Quantity matters here. If only <10 abnormal cells meet criteria for HGUC, classify as SHGUC. This is the diagnostic approach used by Dr. Barkan. So AUC is classified as “mild Atypia,” HGUC and SHGUC are classified as “severe atypia” with similar nuclear features but different quantities. N/C ratio is an important diagnostic criterion in TPS. Studies show human eyes are accurate in estimating N/C ratios close to 0.7 but less accurate close to 0.5. The chart is helpful in training your eyes to estimate N/C ratios. Next is LGUN: Low-Grade Urothelial Neoplasm, which includes papilloma, papillary neoplasm, and LG UC. Diagnostic criteria include: • 3D cell clusters with definitive fibrovascular cores. Studies show cell blocks help identify fibrovascular cores, but cell blocks are not routinely done in most practices. • In our practice, LGUN is a very difficult diagnosis without concurrent biopsy or cystoscopic correlation. The last category is “Other Malignancies,” including primary carcinomas (urothelial, squamous, glandular), secondary malignancies (extension from adjacent organs like prostate or RCC), and metastases. A few examples: • Adenocarcinoma: Eccentrically placed irregular nuclei, clumped and hyperchromatic chromatin, finely vacuolated cytoplasm. • Clear cell RCC: “Hobnail” cell configuration, abundant clear/vacuolated cytoplasm, centrally located nucleus, prominent nucleolus. • Lymphoma and melanoma can also be seen. This table illustrates the risk of HGUC and clinical management for each TPS diagnostic category. Specific points: • Management of AUC: This has been a dilemma. AUC used to include a wide spectrum from benign to malignant. Now, under TPS, conditions like reactive, polyoma, urolithiasis, treatment effect are NHGUC. AUC rate is lower in most practices for TPS, and AUC is a more serious diagnosis. • Potential value of ancillary tests like FISH, especially for AUC and SHGUC. In our recent publication in Cancer Cytopathology, Dr. Shan and I studied the impact of implementing TPS at Inform Diagnostics, studying >27,000 cases for 2 years before and after TPS implementation. Our data showed AUC decreased from 29% to 6.2%. Breaking down by specimen: • Voided urine: AUC decreased from 27% to 6% (75% decrease) • Instrumented urine: AUC decreased from 37% to 9% (75% decrease) We also examined UroVysion FISH results and follow-up surgical results when available for different urinary cytology diagnoses. • AUC associated with positive FISH increased from 16.7% to 37.6%. • AUC associated with follow-up HGUC increased from 9% to 57%. This table shows the cytology performance in detecting urothelial carcinoma. The performance of AUC for detecting HGUC was significantly improved (red font). Specificity increased from 49% to 86%. Positive predictive value improved from 9% to 39%. Accuracy improved from 50% to 85%. In conclusion, implementing TPS resulted in a significant decrease in atypical diagnoses and significant improvement in specificity and PPV in detecting HGUC. AUC was significantly better correlated with UroVysion results, decreasing UroVysion test requests and saving medical costs. AUC should be considered a clinically relevant group requiring serious clinical workup in the TPS era. Lastly, urinary cytology has low sensitivity in detecting LGUN. Sensitivity may be even lower in TPS. It is important for urologists to understand the limitations of urinary cytology and implications of changes introduced by TPS to best manage patient care. Thank you."

Hi doctor I have been diagnosed with adrenal adenoma on the left side and I'm on eplenerone. Is there a possibility of getting an AVS done in India?

Outstanding lecture Sir; God bless you and your family

Outstanding! Thank you!

Gracias por estas charlas, siempre las estoy visitando para refrescar la memoria

Great lecture Dr. Lal! Thank you!!

Tq❤

This was a simply excellent lecture - thank you so much, you are a gifted teacher Dr Shah!

Thank you Sir. 🙏🙏

Thank you Dr Wei Tian for the excellent presentation and thanks to Shah for inviting Dr Wei Tian

Excellent presentation Thanks for your valuable videos

Thanks 👍👍👍

Sir amazing lecture. If you could also consider making a video on how to screen TURPs and when to suspect a sneaky Prostatic adenoca in TURPs when you have 25 slides to see! 😅

Thankyou doc.I found it very helpful .! From Ethiopia

Excellent presentation. Thank you for posting. I hope you don’t mind me asking a question. TURBT was done for bladder tumor in 62 year old man and on microscopic examination, there are prominent polyploid projections (no true papillae) with marked acute inflammation and exuberant eosinophils in mucosa, submucosa and muscularis propria (no necrosis in the latter). Is eosinophilic cystitis (EC) the correct diagnosis? EC is rare but we recently encountered 3 cases with similar histology making us question this diagnosis. Thank you very much.