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Reactive Urothelial Atypia : Cyclophosphamide Therapy

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This 58 y/o female patient received cyclophosphamide therapy for Wegener's granulomatosis and developed gross hematuria. Cystoscopy showed hemorrhagic and congested urothelium. Biopsy shows nuclear irregularity, hyperchromasia, and multinucleation. Cases of secondary urothelial carcinoma-in-situ have been reported following cyclophosphamide therapy making the distinction between reactive and neoplastic changes challenging.

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