• Normal features of urinary diversion (ileal conduit) urine specimens 
  • Cellular smears showing intestinal epithelium, which exfoliates more generously than urothelium. 
  • Intestinal epithelial cells
    • Acquire small rounded contours
    • Show degenerative changes, and may have a histiocytoid appearance
  • Background may be ‘dirty”
    • Variable inflammatory cells
    • Amorphous debris and bacteria 
  • Gastrointestinal mucus and faecal material should not be present. Presence of these elements are suggestive of an entero-urinary fistula. 
• Unusual components in this specimen
  • Mucin-like material 
    • Purple/bright blue on Pap stain
    • Fibrillary edges
    • Central striations
  • Large, plant-like cells
    • Elongated to polygonal cells occurring in isolation, small aggregates or larger clusters forming ‘plant cell-like’ structures 
    • Thick, rigid and waxy cell borders
    • Densely-staining central, reddish/deep orange core
    • Pericentral granular basophilic material in some cells

• Discussion: 
  • Vegetable/plant cell-like structures have been reported in urinary bladder diversion cytology specimens [1-3]
  • 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]
  • In most cases, these vegetable cell-like structures were admixed with lubricant jelly [1]

• Differential diagnoses: 
  • Faecaluria indicating a fistula between urinary and intestinal tract
    • Cellular heterogeneity e.g. presence of degenerate striated muscle from ingested meat in addition to vegetable matter would favour faecaluria 
    • Plant cells from ingested vegetable material may also show degenerative features
    • Clinical corroboration should be sought, e.g. infective symptoms, pneumaturia, faecal material in urostomy bag, suggestive imaging findings
  • Parasitic ova (e.g. schistosomiasis) 
  • Thick waxy appearance may mimic viral inclusions (e.g. Molluscum bodies)

[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.
[2] Planinšek T, Kladnik A, Pohar-Marinšek Z, Fležar MS. Vegetable cells in urinary samples of patients with bricker ileal conduit. Diagn Cytopathol 2014;42(2):120-4. 
[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.

• Urine, bladder diversion (ileal conduit) cytology specimen:
  • No malignant cells seen; Vegetable cell contaminant from urostomy bag adhesive