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49 year old male. I never smoked. do not work with chemicals. on routine physical microscopic hematuria was found +1 level. tested again 2 wks same +1. my primary ordered a voided cytology. came back dx " rare urothelial cells noted in a backround of acute inflammation". saw urologist. he did a cystoscopy. the only thing he saw was a small red spot. did a bladder wash cytology. came back
dx " numerous papillary fragments of uroepithelial epithelium. these findings can be seen with instrumentation or a low grade lesion cant be ruled out". my obvious concern is CIS. my uro said that the lesion was not velvety in appearance and did not look like cis, but he said 20% of the time they don't appear classic. the cytologist suggested a low grade lesion. Q!-if this were cis wouldn't that have showed up on the cytology as a high grade lesion. Q2-are papillary fragments a part of cis. uro was positive he saw nothing else. he told me cis can be low grade? Q3- primary cis is very rare from what I understand. I need your honest opinion as to the odds I have cis or a low grade pappilary lesion. don't pull any punches. thank you, patrick

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
 32 Doctors Online

Thank you for your query at

Dear sir,


The pathologist saw numerous fragments of papillary urothelium. Urothelium(urinary tract lining) is normally papillary and hence what the pathologist saw is just normal epithelium(lining) and nothing else. The CIS is high grade and is very rarely low grade.

Specifically answering each of your questions;

Q1- Yes, if it were CIS, it would have shown up on cytology as an abnormal result which is not the case.

Q2- No, the papillary fragments were normal epithelium and not CIS.

Q3- Yes primary CIS of urinary tract is very rare and you do not have it.

You are not suffering from anything and what the pathologist saw is normal epithelium.


Stay reassured. Let me know if you have any queries.



Dr Rajiv Goel,

MS (AIIMS), MCh (AIIMS), DNB ( Uro),

Fellow, Urooncology and Robotic urology, Australia,

Fellow, Laparoscopic urology, Germany,

Consultant Urologist.

Patient replied :

thank you. so the red spot on my bladder wall that he saw on cytoscopy can be a normal finding. q1- what % of the time when you are performing cytoscopy do you find a red spot . q2- what % of these turn out to be cancer. q3-if not cancer what can cause this and what can it be? i did forget to mention i had both contrast and a no contrast ct scan. the only finding was mild bph. benign prostate hyperplasia.

Dear Sir,

One can find red spot in the bladder in virtually all patients who are above the age of 45 yrs and have enlarged prostate. In majority ( 95%) of patients these lesions have no significance. So you should not be worried in this case.


Take care.



Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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