Fluid & Brush Quiz 21 This patient is a 63 year-old white male smoker. He had a partial sigmoid-colectomy for colon cancer 3 years before presentation.  Two years ago he had a biopsy of the urinary bladder that showed a high grade carcinoma without invasion.  He presents now with hematuria.  A urinalysis confirms the presence of microscopic blood. The patient states that he is weak and unable to work but is able to get around the house without difficultly.  He has no other symptoms.  Cystoscopy reveals no definite lesion.  Bladder washings are taken and representative photos are presented below. The most appropriate diagnosis is:

A Candidiasis with inflammatory repair.

B Inconclusive, favor carcinoma.

C Metastatic adenocarcinoma of the colon.

D Transitional cell carcinoma, high-grade.