High-grade urothelial carcinoma (bladder washing, cytospin, Papanicolaou stain, 600×). This urine specimen has numerous cells with high N/C ratio (>0.7), demonstrating nuclear hyperchromasia, coarse chromatin, and irregular nuclear membranes. Most cells have a plasmacytoid appearance with eccentrically placed nuclei. The background has a significant number of red blood cells, which is commonly seen in cytospin preparations.