HI Bills, a few points.
As I might have mentioned before the cytology reporting system has changed to improve the accuracy of the reporting, namely recognizing that cytology is more focused on detecting high grade and, reducing atypical, and only reporting low grade if the urine sample includes a specific feature. If the sample does not fit to those categories, it needs to say insufficient sample or something like that. I think the description of the report, stating few transitional and occasional epithelial cells might have meant that there were not enough cells to confirm "Negative for malignancy" or "Negative for high-grade urothelial carcinoma.". Literatures say less than 10-20 urothelial cells, obscuring inflammation, blood may lead to inadequate analysis. The report is the communication media between the pathologist and the urologist, and I assume they have been communicating for many samples, so I think it is best to wait for the urologist to read the report and explains to you.
Traditional Cytology Terminology The Paris System (2013)
Negative for malignancy Negative for high-grade urothelial carcinoma
Atypical cells present Atypical urothelial cells
Suspicious for malignancy Suspicious for high-grade urothelial carcinoma
Positive for malignant cells High-grade urothelial carcinoma
(Low-grade urothelial neoplasia)
I am also more concerned with the reporting of "Many acute inflammatory cells, RBCs, amorphous deposits". Google says there are acute and chronic inflammations. The physical, chemical and other factors can cause injury to tissue- in your case, the lining (epithelial tissue) of bladder I presume. The early reaction to the injury is the same regardless how the tissue is injured. First, capillary, through which usually one blood cell ,i.e. one RBC can pass, expand so more RBCs flow and become permeable so blood reaches to injured tissue to deliver more oxygen to generate more energy to kill and repair injured cells, produce more cells. At the same time, immune cells. initially Neutrophil (WBC) in blood will also reach to injured tissue. 50 to 70% of all circulating WBCs are Neutrophils. The major role of the neutrophil in acute inflammation is to kill microorganism and foreign material. In chronic inflammation, usually Monocytes which make up 2-8% circulating WBCs enter into the tissue and become Macrophage. Macrophages engulf large particles and pathogens.
So, the pathologist report mentioning of acute inflammatory cells indicates there is recent injury to the bladder lining, or upper tract. But, knowing that your dad had severe injuries to the lining by BCG induction treatment, initially, and subsequently the one maintenance treatment in June, which also caused some issue, concern is that the report leads to acute (recent) inflammation, but it could be that the lining of bladder has developed chronic inflammation, such as cystitis. It is something you need to discuss with urologist to find out the nature of the inflammation before the next BCG is infused.
We know that the side effects tend to get worse as the number of the BCG treatment increases. I have read only 20% completes the whole BCG treatment regimen. But I have also read Dr. Kamat of MD Andersons saying that that was the past and because urologists learned much bout side effects and how to deal with it, that in his practice, over 90% of his patients could complete the entire 3 years BCG treatment program. Dr. Kamat did not explain how (medication, reducing dosed?) 90% of his patients were able to complete it.
Incidentally, does your dad show any symptoms for inflammation in the bladder, such as frequency, urgency, blood in urine, etc?
best