Synchronous uterine and bladder cancers detected in urine and vaginal samples by cytology

Nadira Narine, Durgesh Rana, David Shelton, Dina Awad, Helena O'Flynn, Eleanor Jones, Neil A. J. Ryan , Emma Crosbie

Research output: Contribution to journalArticlepeer-review


Novel diagnostics for uterine cancer are urgently needed to reduce the burden of invasive testing for the majority of healthy women with postmenopausal bleeding. We have previously shown that uterine cancer cells can be detected by cytology in urine and vaginal samples with high diagnostic accuracy. Here, we demonstrate its potential to distinguish malignant cells of different aetiologies in the same urogenital biofluid sample according to their distinctive morphology and immunoprofiles. Synchronous tumours of the urogenital tract are uncommon but can cause diagnostic confusion, delays and poor outcomes. A 79-year-old woman presented to accident and emergency with postmenopausal bleeding. Voided urine and Delphi screener-collected vaginal samples were assessed by cytology and immunocytochemistry. Two malignant cell populations with distinct morphology and immunophenotypes consistent with synchronous uterine and urothelial tumours were identified. Subsequent routine diagnostics confirmed concurrent uterine carcinosarcoma and high-grade urothelial carcinoma of the bladder. This case demonstrates that cytology and adjunctive immunocytochemistry can simultaneously identify and phenotype cancers of different aetiologies from a single urogenital biofluid sample. This can help rationalise diagnostic pathways in complex, unusual cases of dual urogenital primaries.
Original languageEnglish
Pages (from-to)E86-E91
JournalDiagnostic Cytopathology
Issue number3
Early online date16 Nov 2021
Publication statusPublished - 1 Mar 2022


  • cytology
  • urine
  • uterine cancer
  • endometrial cancer
  • immunocytochemistry
  • non-invasive diagnostics

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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