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Anatomic pathology > Bladder > Flashcards

Bladder Flashcards

1
Q

Urothelial carcinoma of the ureter: Main prognostic factors (3).

A

Stage.

Grade.

Presence of synchronous tumor in renal pelvis.

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2
Q

Malakoplakia: Typical patient.

A

Woman in her fifth decade.

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3
Q

Malakoplakia: Gross pathology.

A

Multiple soft, yellow-white, nodular plaques on the mucosa.

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4
Q

Histiocytes of malakoplakia:

A. Name.
B. Location.
C. Appearance.

A

A. Von Hansemann’s histiocytes.

B. Superficial lamina propria.

C. Abundant eosinophilic granular cytoplasm.

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5
Q

Michaelis-Gutmann bodies of malakoplakia:

A. Location.
B. Composition.

A

A. Within the histiocytes and in the interstitium.

B. Bacteria encrusted with calcium and iron.

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6
Q

Malakoplakia: Other histopathologic features (2).

A

Fibrosis.

Acute and chronic inflammation.

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7
Q

Malakoplakia: Putative pathophysiology.

A

Mononuclear cells cannot degrade bacteria normally.

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8
Q

Clinical associations:

A. Polypoid cystitis.
B. Follicular cystitis (2).
C. Giant-cell cystitis.

A

A. Indwelling catheter.

B. Bladder carcinoma; urinary-tract infection.

C. None; a pathologic rather than clinical diagnosis.

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9
Q

Polypoid cystitis: Histopathology (2).

A

Broad fronds covered by benign urothelium.

Edematous, inflamed, congested lamina propria.

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10
Q

Giant-cell cystitis: Histopathology (2).

A

Atypical large cells with tapering processes; may be multinucleate.

Very few or no mitotic figures.

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11
Q

Granulomatous cystitis secondary to BCG therapy: Gross pathology.

A

Partial or complete mucosal denudation.

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12
Q

Granulomatous cystitis secondary to BCG therapy: Histopathology (3).

A

Lamina propria: Noncaseating granulomas surrounded by lymphocytes.

Urothelium: Reactive atypia or denudation.

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13
Q

Granulomatous cystitis secondary to BCG therapy: Special stains.

A

AFB stain rarely discloses bacteria.

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14
Q

Ureteritis cystica and ureteritis: Histopathology.

A

Both represent cystic change in von Brunn’s nests.

Ureteritis glandularis: Lined by columnar cells.

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15
Q

Ureteritis cystica:

A. Etiology.
B. Gross pathology.

A

A. Inflammation.

B. Nodular mucosa secondary to cysts.

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16
Q

Urothelial carcinoma of the ureter: Risk factors (3).

A

Smoking.

Analgesics.

HNPCC.

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17
Q

Urothelial carcinoma of the ureter: Most frequent location.

A

Lower third of the ureter.

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17
Q

Radiation cystitis: Timing (2).

A

Acute symptoms: 4-6 weeks after radiation.

Later symptoms: Up to 10 years after radiation.

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18
Q

Radiation cystitis: Gross pathology.

A

Mucosal hyperemia and edema with thick folds.

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19
Q

Radiation cystitis: Earlier histopathology (4).

A

Lamina propria: Edema and hyperemia.

Urothelium: Atypia with preserved N:C ratio.

Vessels: Dilatation, fibrin deposition.

Stroma: Inflammation, extravasated erythrocytes.

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20
Q

Radiation cystitis: Later histopathology (3).

A

Lamina propria: Fibrosis.

Urothelium: Ulceration.

Vessels: Myo-intimal proliferation or medial hyalinization.

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21
Q

Hemorrhagic cystitis: Earlier histopathology (2).

A

Lamina propria: Hemorrhage, congestion.

Urothelium: Regenerative atypia.

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22
Q

Hemorrhagic cystitis: Later histopathology (2).

A

Lamina propria: Fibrosis.

Urothelium: Hyperplasia with formation of papillae.

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23
Q

Interstitial cystitis: Possible laboratory finding.

A

Hematuria.

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24
Q

Interstitial cystitis: Possible cystoscopic findings (3).

A

Petechial hemorrhage.

Linear ulcers.

Mucosal scarring.

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25
Q

Interstitial cystitis: Later gross finding.

A

Fibrotic and contracted bladder with diminished capacity.

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26
Q

Interstitial cystitis: Early histopathology.

A

Mucosal microhemorrhages.

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27
Q

Interstitial cystitis: Histopathology of ulcerative phase (3).

A

Fibroinflammatory infiltrate.

Increase in mast cells.

Hemorrhage, congestion, fibrosis.

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28
Q

Interstitial cystitis: Main differential diagnosis.

A

Carcinoma in situ must be excluded before interstitial cystitis can be diagnosed.

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29
Q

Cystitis glandularis: Immunohistochemistry.

A

CK20 highlights the umbrella cells only.

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30
Q

Von Brunn’s nests vs. nested variant of urothelial carcinoma (3).

A

Von Brunn’s nests:

− Lobular or linear arrangement of nests.
− Flat, noninfiltrative base.
− No cytologic atypia.

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31
Q

Nephrogenic adenoma:

A. Epidemiology.
B. Risk factors (4).

A

A. Young adults; more frequent in males.

B. Surgery, trauma, calculus, cystitis.

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32
Q

Nephrogenic adenoma: Location in the bladder.

A

Posterior wall.

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33
Q

Nephrogenic adenoma: Histologic architecture.

A

May resemble renal tubules or form papillae.

Pink secretions may fill the tubules.

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34
Q

Nephrogenic adenoma: Cytology.

A

Bland, mitotically inactive “hobnail” cells line the tubules.

Acute and chronic inflammatory cells may infiltrate the stroma.

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35
Q

Nephrogenic adenoma: Pitfall.

A

Infiltration beyond the lamina propria should not be mistaken for malignant behavior.

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36
Q

Nephrogenic adenoma: Immunohistochemistry (3,2).

A

Positive: CK7, PAX2, PAX8.

Negative: p63, GATA3 (expressed in invasive urothelial carcinoma).

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37
Q

Nephrogenic adenoma: Putative origin.

A

Renal tubular cells.

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38
Q

Urothelial hyperplasia: Histopathology.

A

More layers of cells than in the adjacent, normal urothelium.

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39
Q

Urothelial hyperplasia: Mutation.

A

May express deletions of chromosome 9.

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40
Q

Urothelial hyperplasia: Rate of progression to urothelial neoplasia.

A

0%.

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41
Q

Urothelial dysplasia: Histopathology (4).

A

Loss of polarity.

Nuclear crowding.

Mild nuclear enlargement and atypia.

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42
Q

Urothelial dysplasia: Immunohistochemistry (3).

A

Aberrant expression of CK20.

Overexpression of p53, Ki-67.

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43
Q

Urothelial dysplasia: Rate of progression to urothelial neoplasia.

A

5% to 19%.

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44
Q

Urothelial atypia of unknown significance.

A

Significant atypia in a background of inflammation.

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45
Q

Urothelial carcinoma in situ: Nuclear features (2).

A

Identical to those of high-grade papillary urothelial carcinoma.

Mitotic figures high in the urothelium.

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46
Q

Urothelial carcinoma in situ: Immunohistochemistry (3).

A

CK20 and p53 may show full-thickness reaction.

CD44: Negative or limited to the basal layer.

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47
Q

Papillary urothelial hyperplasia: Histopathology (2).

A

Papillae lined by normal-appearing urothelium.

No branching.

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48
Q

Papillary urothelial hyperplasia: Significance.

A

May progress to low-grade papillary urothelial carcinoma.

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49
Q

Urothelial papilloma: Typical presentation.

A

Gross hematuria.

50
Q

Urothelial papilloma: Histopathology (3).

A

Branching papillae.

Enlarged, vacuolated umbrella cells.

No mitotic figures, not even in the basal layer.

51
Q

Urothelial papilloma: Immunohistochemistry.

A

CK20 highlights the umbrella cells only, as in normal urothelium.

52
Q

Urothelial papilloma: Significance and management.

A

May progress to higher-grade disease.

Should be completely excised.

53
Q

Inverted papilloma: Age range.

A

May occur at any age; median age is 55 years.

54
Q

Inverted papilloma: Locations (3).

A

Trigone.

Neck.

Prostatic urethra.

55
Q

Inverted papilloma: Presentation.

A

Hematuria.

56
Q

Inverted papilloma: Histopathology.

A

Uniform, anastomosing cords of bland urothelial cells extend into the lamina propria.

57
Q

Inverted papilloma: Stroma.

A

Minimal; no inflammation.

58
Q

Inverted papilloma:

A. Significance.
B. Treatment.

A

A. Uncertain whether it can progress to low-grade papillary urothelial carcinoma.

B. Resection.

59
Q

Papillary urothelial neoplasm of low malignant potential: Degree of cytologic atypia.

A

Minimal or absent.

60
Q

Papillary urothelial neoplasm of low malignant potential: Immunohistochemistry.

A

CK20 highlights the umbrella cells only.

61
Q

Papillary urothelial neoplasm of low malignant potential vs. low-grade papillary urothelial carcinoma.

A

Low-grade papillary urothelial carcinoma:

− Easily recognizable variation in architectural and cytologic features.
− Mitotic figures are more than rare and can occur at any level.

62
Q

Low-grade papillary urothelial carcinoma, noninvasive: Immunohistochemistry.

A

CK20: Negative or focally reactive.

63
Q

Low-grade papillary urothelial carcinoma, noninvasive: Rate of progression to death.

A

5%.

64
Q

High-grade papillary urothelial carcinoma, noninvasive: Immunohistochemistry (2).

A

CK20 and p16: Strong and diffuse reactivity.

65
Q

Invasive urothelial carcinoma: Risk factors (5).

A

Tobacco.

Nitrosamines.

Phenacetin.

Cyclophosphamide.

Schistosomes.

66
Q

Papillary urothelial carcinoma, noninvasive: Architecture difference between low- and high-grade types.

A

Low-grade: Papillae are slender and show minimal fusion.

High-grade: Papillae are more fused and may become indistinct.

67
Q

Papillary urothelial carcinoma: Significance of invasion of fat.

A

The fat may lie between bundles of muscularis propria rather than outside the bladder.

68
Q

Invasive papillary urothelial carcinoma: Types of divergent differentiation (2).

A

Squamous (most common).

Glandular.

69
Q

Invasive papillary urothelial carcinoma: Histopathology of glandular differentiation.

A

Tubular or enteric; may secrete mucin.

70
Q

Invasive papillary urothelial carcinoma, nested variant: Histopathologic significance.

A

May be misdiagnosed as von Brunn’s nests.

71
Q

Invasive papillary urothelial carcinoma, nested variant, vs. von Brunn’s nests (2).

A

von Brunn’s nests:

− Larger.
− Smooth, noninfiltrative deep margin.

72
Q

Papillary urothelial neoplasm of low malignant potential vs. urothelial papilloma (2).

A

PUNLMP: Thicker and more crowded urothelium.

73
Q

Invasive papillary urothelial carcinoma, nested variant: Prognosis.

A

Death in 4 to 40 months in 70% of patients.

74
Q

Invasive papillary urothelial carcinoma, large-nested variant: Histopathology (2).

A

Large nests of deceptively bland cells in a fibrotic stroma.

Often invades muscularis propria.

75
Q

Invasive papillary urothelial carcinoma, large-nested variant: Surface component.

A

When present, usually low-grade papillary urothelial carcinoma.

76
Q

Invasive papillary urothelial carcinoma, micropapillary variant: Histopathology (3).

A

Surface: Fine papillae and micropapillae.

Invasive component: Minute nests or fine papillae; retraction artifact simulates lymphatic invasion.

Muscle is always invaded.

77
Q

Invasive papillary urothelial carcinoma, micropapillary variant: Grade.

A

Always high-grade.

78
Q

Invasive papillary urothelial carcinoma, lymphoepithelioma-like:

A. Reporting.
B. Treatment.

A

A. Proportion of lymphoepithelioma-like component should be estimated.

B. Pure lymphoepithelioma-like carcinoma responds to chemotherapy.

79
Q

Invasive papillary urothelial carcinoma:

A. Cytokeratins (2).
B. Other markers (3).

A

A. CK7, CK20.

B. CD15, CEA, GATA3.

80
Q

Mutations associated with invasive papillary urothelial carcinoma:

A. Earlier.
B. Later (4).

A

A. Loss of 9p.

B. Abnormalities of 17p; aneuploidy involving chromosomes 3, 7, 17.

81
Q

Invasive papillary urothelial carcinoma: Stages.

A

T1: Invasion of lamina propria.

T2a: Superficial muscularis propria.

T2b: Deep muscularis propria.

T3: Perivesical soft tissue.

T4: Contiguous organs or tissues.

82
Q

Villous adenoma: Locations (3).

A

Urachus.

Dome.

Trigone.

83
Q

Villous adenoma: Presentation.

A

Hematuria, occasionally with mucosuria.

84
Q

Villous adenoma: Significance.

A

Often accompanied by adenocarcinoma.

85
Q

Villous adenoma: Histopathology.

A

The epithelium is similar to that of colonic villous adenoma.

86
Q

Villous adenoma: Immunohistochemistry (3).

A

Positive: CK20, CK7, CEA.

87
Q

Adenocarcinoma of the bladder: Main types.

A

Non-urachal: About ⅔ of cases.

Urachal.

88
Q

Non-urachal adenocarcinoma: Presentation.

A

There is metastatic disease at presentation in 40% of cases.

89
Q

Non-urachal adenocarcinoma: Risk factors (3).

A

Non-functioning bladder.

Exstrophy.

Schistosomes.

90
Q

Urachal adenocarcinoma:

A. Mean age at presentation.
B. Laboratory finding.

A

A. 50 years.

B. Mucosuria (in 25% of cases).

91
Q

Non-urachal adenocarcinoma: Locations (2).

A

Trigone.

Posterior wall.

92
Q

Non-urachal adenocarcinoma: Cause of false-negative biopsy.

A

Signet-ring variant has no surface component and infiltrates the bladder wall like linitis plastica.

93
Q

Urachal adenocarcinoma: Locations (2).

A

Done of bladder.

Anterior abdominal wall.

94
Q

Urachal adenocarcinoma: Gross pathology (2).

A

Mucinous cut surface.

Overlying bladder mucosa may be intact or ulcerated.

95
Q

Adenocarcinoma of the bladder: Histopathologic patterns (3).

A

Malignant glands infiltrating the bladder wall.

Pools of mucin containing neoplastic cells.

Signet-ring cells.

96
Q

Adenocarcinoma of the bladder wall: Precursor lesions (2).

A

Intestinal metaplasia or adenocarcinoma in situ may be seen with non-urachal carcinomas.

97
Q

Adenocarcinoma of the bladder: Features that favor urachal origin (4).

A

Location in dome or anterior wall.

Normal adjacent mucosa.

Location of bulk of tumor within bladder wall.

No evidence of alternative origin, e.g. urothelial carcinoma, cystitis cystica, other adenocarcinoma.

98
Q

Adenocarcinoma of the bladder: Cytokeratins (2).

A

Positive: CK20.

Variable: CK7.

99
Q

Adenocarcinoma of the bladder: Other immunohistochemical stains (3,1).

A

Positive: CEA, villin (in the enteric type), CDX-2.

Negative: β-Catenin (nuclear staining).

100
Q

Squamous-cell carcinoma: Risk factors (4).

A

Schistosomes.

Tobacco.

Calculi.

Indwelling catheters.

101
Q

Squamous-cell carcinoma: Differential diagnosis.

A

Urothelial carcinoma with squamous differentiation: Retains some urothelial component.

102
Q

Squamous-cell carcinoma: Behavior (2).

A

Local recurrence is more common than metastasis.

Bone is the most frequent site of metastasis.

103
Q

Small-cell carcinoma: Epidemiology.

A

Typically occurs in elderly men.

104
Q

Small-cell carcinoma: Feature favoring origin in the bladder.

A

Persistence of urothelial component.

105
Q

Inflammatory myofibroblastic tumor: Presentation.

A

Gross hematuria.

106
Q

Inflammatory myofibroblastic tumor:

A. Tumor cells.
B. Inflammatory cells.

A

A. Myofibroblastic cells in “tissue-culture” pattern.

B. Lymphocytes, plasma cells, sometimes many eosinophils.

107
Q

Inflammatory myofibroblastic tumor: Other histologic components (2).

A

Conspicuous network of thin-walled blood vessels.

Edematous or myxoid stroma.

108
Q

Inflammatory myofibroblastic tumor: Mitotic activity.

A

Mitotic figures may be many but are not atypical.

109
Q

Inflammatory myofibroblastic tumor: Immunohistochemistry (2,1,1).

A

Positive: ALK (⅔ of cases), SMA.

Variable: Cytokeratins.

Negative: Desmin.

110
Q

Inflammatory myofibroblastic tumor: Gene and its location.

A

ALK on chromosome 2p23.

111
Q

Most common sarcoma of the bladder in older adults.

A

Leiomyosarcoma.

112
Q

Rhabdomyosarcoma: Epidemiology (2).

A

Most common bladder tumor in children.

Typically occurs before the age of 5.

113
Q

Rhabdomyosarcoma: Most common subtypes (2).

A

Children: Embryonal.

Adults: Pleomorphic.

114
Q

Rhabdomyosarcoma:

A. Location.
B. Relevance of gross appearance to prognosis.

A

A. Trigone.

B. Better if exophytic and mostly intraluminal.

115
Q

Rhabdomyosarcoma: Histopathology (3).

A

Small round blue cells.

Loose myxoid matrix.

Strap cells may be seen.

116
Q

Rhabdomyosarcoma: Most helpful immunohistochemical stains.

A

Positive: Myogenin (myf4) and MyoD1.

117
Q

Carcinosarcoma / sarcomatoid carcinoma: Risk factors.

A

Cyclophosphamide.

Radiation.

118
Q

Carcinosarcoma / sarcomatoid carcinoma: Histological components (3).

A

Malignant epithelial component.

Malignant mesenchymal component.

Some tumors: Heterologous differentiation.

119
Q

Histology of components of carcinosarcoma / sarcomatoid carcinoma:

A. Epithelial (3).
B. Mesenchymal.
C. Heterologous.

A

A. Urothelial, glandular, or small-cell.

B. High-grade spindle-cell.

C. Most commonly osteosarcoma.

120
Q

Carcinosarcoma / sarcomatoid carcinoma: Cytokeratins.

A

Reactive in the epithelial component and sometimes in the mesenchymal component.

121
Q

Metastasis to the bladder: Most frequent primary sites (4).

A

Breast.

Colon.

Kidney.

Melanoma.

122
Q

Immunohistochemical stains that support prostatic origin of a metastatic tumor (4).

A

PSA.

PSAP.

p501s.

NKX3.1.

123
Q

Immunohistochemical stains that support colonic origin of a metastatic tumor (4).

A

Villin.

CDX-2.

Anatomic pathology (17 decks)

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