CYTOLOGY OF HUMAN URINARY SEDIMENT: DIAGNOSTIC VALUE OF THE NONNUCLEATED CELL*

Abstract

Epithelial cells of the distal urethra (studied in voided specimens of urine) respond in the same way to ovarian steroids as do the cells of the vaginal mucosa, throughout a normal menstrual cycle. Among these urinary cells, a non-nucleated, acidophllic amorphous structure termed the ''non-nucleated cell'' is present normally in the proportion of 1 to 20 per cent. When these non-nucleated structures are included in a count of 100 cells, striking variations are consistently observed in several pathologic conditions. We have confirmed the original observations of Galli Mainini that these non-nucleated elements are found in greatest abundance in urinary smears after castration. They are therefore an index of ovarian deficiency rather than of ovarian estrogenic stimulation. They are increased in ovarian dysgenesis, but reduced by estrogen therapy. Similarly, they are at a high level in cases of polycystic ovaries, but drop precipitately after wedge resection. The high level seen after oophorectomy in patients with breast cancer falls abruptly after hypophysectomy. In cases of anovulatory menstrual cycles, secondary amenorrhea or early pregnancy, the proportion of non-nucleated cells is low. It is postulated that, in the absence of functioning ovaries, the adrenals produce an estrogenic substance capable of supporting partial development of the urethral epithelium. With this support, the urethral cells are shed in a semi-degenerate state, without nuclei, but they do not revert to the wholly atrophic picture seen when the adrenal is also inactivated. It is felt that the changes in the level of the non-nucleated cells represent a significant compensatory mechanism of the adrenal in ovarian-deficient states. The percentile counts in 60 patients with various conditions are presented in support of these views.