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CPR II Exam 2 > Ch 21 > Flashcards

Ch 21 Flashcards

1
Q

Whats the most common cause of hydronephrosis in infants and kids?

A

ureteropelvic junction (UPL) obstruction

  • early cases more likely to be bilateral and happen in males
  • in adults, more common in women and bilateral
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2
Q

What can urinary stasis lead to if a diverticula is present?

A

recurrent infection

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3
Q

tumor-like lesion that presents as a small mass projecting into the lumen

  • often in children
  • may also occur in the bladder, renal pelvis, and urethra
A

fibroepithelial polyp

- composed of loose, vascularized connective tissue overlaid by urothelium

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4
Q

what are the most common primary malignant tumors or the ureters?

A

urothelial carcinomas

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5
Q

what type of tissue are renal pelvic carcinoma, bladder malignancy and ureteral carcinoma made up of?

A

urothelial tissue

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6
Q

what can an obstruction of the ureteral lumen lead to?

A

hydronephrosis

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7
Q

fibrotic proliferative inflammatory process encasing the retroperitoneal structures, causing hydronephrosis

  • more common in middle aged men
  • associated with IgG4-related diseases
A

Sclerosing Retroperitoneal Fibrosis

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8
Q

What are the other causes of sclerosing retroperitonial fibrosis?

A
  1. drug exposures (ergot derivatives, beta-blockers)
  2. adjacent inflammatory processes (vasculitis, diverticulitis)
  3. malignant disease (lymphomas, urinary tract carcinomas
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9
Q

What is the treatment for sclerosing retroperitoneal fibrosis?

A

corticosterioids, but will need stents or surgery (uterolysis = exctrication of the ureters from the surrounding fibrous tissue)

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10
Q

What can cause a urinary bladder diverticula?

A

often due to increase in intravesical pressure

NOTE: advanced carcinoma is possible, and more advanced as a result of the thin or absent muscle wall of diverticula

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11
Q

development failure of the anterior abdominal wall

- exposed bladder mucosa may undergo colonic glandular metaplasia and is subject to infections

A

exstrophy of the bladder

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12
Q

what is the treatment for bladder exstrophy?

A

surgery -> long term survival

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13
Q

what is a urachal cyst?

A

only the center part is patents and lined by urothelium or metaplastic glandular epithelium

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14
Q

E.coli, proteus, klebsiella, enterobacter, chlamydia, mycoplasma, t.cyctisis, candica albicans, and schistoma can all cause what?

A

cystitis

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15
Q

bladder calculi, urinary obstruction, DM, instrumentation (catheter), immune defficiency and irradiation of the bladder are all predispositions to what?

A

cystitis

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16
Q

hyperemia of the mucose and neutrophillic infiltrate (sometimes with exudate)

A

acute cystitis

NOTE: pt receiving cytotoxic anti-tumor drugs or infected with adenovirus can develop hemorrhagic cyctitis

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17
Q

caused by chronic bacterial infection associated with mononuclear cells

A

chronic cystitis

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18
Q

presence of lymphoid follicles within the bladder mucosa and underlying wall, not al ways related to infection

A

follicular cystitis

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19
Q

infiltration of eosinophils into the submucosa, not always related to infection

A

eosinophilic cystitis

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20
Q

what is the clinic triad of cystitis?

A
  1. frequency (every 15-20 mins)
  2. lower abdominal pain, localized over bladder/suprapubic region
  3. dysuria (pain/burning with urination)
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21
Q

chronic cystitis, usually female

  • pain/dysuria in absence of infection
  • early phase: puntatte hemorrhages
  • late/classic/ulcerative phase: chronic mucosal ulcer (Hunner ulcers) with inflammation and trandmural fibrosis leading to a contracted bladder
  • increased mucosal mast cells
A

interstitial cystitis (Chronic Pelvic Pain Syndrome)

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22
Q

chronic bacterial cystitis (E.coli or proteus)

  • acquired defect of phagocyte function
  • immunocomprimised pt
  • 3-4cm soft, yellow mucosal plaques with foamy macrophages
  • abundant granular PAS-positive cytoplasm
  • Michaelis-gutmann bodies (macrophage with intra-lysosomal laminated calcified concretions -> become giant)
A

Malakoplakia

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23
Q

inflammatory lesion from irritation of bladder mucosa

  • most commonly due to indwelling catheters, but can be due to any injurious agent
  • marked submucosal edema -> broad bulbous polypoid projections
A

polypoid cystitis

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24
Q

can be seen in normal bladders or chronic cystitis (two conditions that often occur together)

  • nests of transitional epithelium (Bunn nests) grow downward into lamina propria
  • nests transform into cuboidal or columnar epithelium (glandularis)
  • flattened cells lining fluid filled cysts
A

cystitis glandularis and cistitis cistica

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25
Q

response to injury

- urothelium replaced by nonkeratizing squamous epithelium (more durable)

A

squamous metaplasia

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26
Q

What should squamous metaplasia be distinguished from?

A

glycosylated squamous epithelium that is normally found in women at the trigone

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27
Q

sloughed tubular cells implant and proliferate at sites of injured urothelium

  • urothelium turns into cuboidal epithelium that assumes a papillary growth pattern
  • possibly extends into superficial detrusor muscle and mimics a malignant process (still benign)
A

nephrogenic adenoma

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28
Q

What tissue type are 95% of bladder cancers from?

A

epithelial origin

- remainder are mesenchymal

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29
Q

What are bladder neoplasms called?

A

urothelial or transitional tumors

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30
Q

90% of all bladder tumors (may arise anywhere that is urothelium)

  • small benign lesions -> aggressive cancers
  • often multifocal at presentation
A

urothelial tumors

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31
Q

What are the two precursor lesions of urothelial tumors?

A
  • noninvasive papillary tumors (most common)

- flat noninvasive urothelial carcinoma (carcinoma in situ)

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32
Q

Where do noninvasive papillary tumors arise from?

A

urothelial hyperplasia

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33
Q

high grade epithelial lesions that have cytological features of malignant cells, but are confined to the epithelium and show no evidence of basement membrane invasion

A

carcinoma in situ

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34
Q

typically appear as a large, ulcerated mass

  • high grade invasive component destroys the precursor lesion
  • invasion into the lamina propria worsens prognosis, but invasion into the muscularis propria (detrusor muscle) is a major factor for survival
A

invasive bladder cancers

35
Q

what are the risk factors for urothelial carcinoma?

A
  • age (50-80), male
  • smoker (50-80% of all bladder cancers associated with cigarette use
  • industrial exposure
  • schistosoma haematobium (Egypt)
  • long term use analgesics
  • irradiation of other pelvic malignancy
36
Q

FGFR3 rtk

A

GOF mutation, oncogene

- noninvasive, low grade papillary carcinomas

37
Q

TP53 and RB

A

LOF mutation, tumor supressor genes

- almost always seen in high-grade invasive tumors

38
Q

HRAS

A

GOF mutation, oncogene
- low-grade non-invasive tumors

NOTE: HRAS and FGFR3 are mutually exclusive in bladder cancer because RAS signal transducers act downstream of rtk’s

39
Q

loss of Xsome 9p

A

specifically loss of CDKN2A tumor supressor gene

- often only abnormality seen in superficial non-invasive papillary tumors and occasionally in non-invasive flat tumors

40
Q

where do most urothelial tumors arise from?

A

lateral and posterior walls of the bladder, at the base

- multiple, discrete tumors often present

41
Q

what are the two characteristics that set papillary urothelial neoplasms of low malignant potential (PUNLMP) apart from papilomas?

A
  1. slightly larger than papillomas

2. thicker urothelium

42
Q

orderly cytology and architecture

  • minimal atypia
  • rarely invade
  • rarely fatal
A

low grade papillary urothelial carcinomas

43
Q

discohesive cells with anaplastic features

  • architectural disarray, loss of polarity
  • large, hyperchromatic nuclei
  • atypical figures

**high risk of invasion into muscular layer, higher risk of progression, and significant metastatic potential

A

high grade papillary urothelial cancer

44
Q

adjacent structure invasion

  • fistulous communications with vagina or rectum
  • 40% to regional LN’s
  • hematogenous spread to liver, lungs, bone marrow
A

metastases of urothelial tumor of the bladder

45
Q

cytological malignant cells within a flat urothelium

  • can range from full thickness atypia to scattered malignant cells in otherwise normal urothelium
  • multifocal, no evident intraluminal mass
A

carcinoma in situ (flat urothelial carcinoma)

46
Q

associated with papillary urothelial cancer, high grade or adjacent CIS
- invasion of muscularis mucosae (detrusor muscle) is prognostically important

A

invasive urothelial cancer

47
Q

why is biopsy “under-staging” a problem with invasive urothelial cancer?

A

staging at the initial diagnosis the the most important factor in determining the outlook for the patient

NOTE: staging = extent of spread

48
Q

associated with chronic bladder irritation and infection

- increased incidence in Middle East (unusual in US)

A

squamous cell carcinoma of the bladder

49
Q

invasive, fungating and/or infiltrating and ulcerating tumors

  • more common than purely squamous cell bladder cancers
  • can be well differentiated or anaplastic
A

mixed urothelial carcinomas with areas of squamous carcinoma of the bladder

50
Q

where do adenocarcinomas of the bladder arise from?

A

some arise from urachal remnants, or in the setting of intestinal metaplasia

51
Q
  • *painless hematuria**
  • frequency, urgency, dysuria
  • pyelonephritis or hydronephrosis may follow if ureteral orifice is involved
  • tend to recur after excision at higher grade in different sites
A

bladder cancer

52
Q

what is the treatment for small, low-grade papillary tumors?

A

diagnostic transurethral resection, follow with cytoscopy and urine cytology

53
Q

what is the treatment for patients at high risk of recurrence?

A

intra-vesical instillation of an attenuated strain of mycobacterium bovis (BCG)
- bacteria elicit a local inflammatory reaction the destroys the tumor

54
Q

what are the most common benign mesenchymal tumors or the bladder?

A

leiomyomas (still rare)

- they grow as isolated, intramural, encapsulated, oval-to-spherical masses

55
Q

what are the most common sarcomas in kids?

A

embryonal rhabdomyosarcomas

- can grow in grape-like mass

56
Q

What are the most common sarcomas in adults?

A

leiomyosarcoma

57
Q

What is the most common cause of bladder obstruction in males?

A

prostate enlargement

- due to nodular hyperplasia

58
Q

what is the most common cause of bladder obstruction in females?

A

cystocele of the bladder

  • bladder wall continues to thicken -> becomes so thick that diverticula forms
  • bladder can also become very enlarged and thinned -> reaching the brim of the pelvis or umbilicus
59
Q

Early manifestation of Neisseria gonorrhea infection, often with a more purulent discharge

A

Gonococcal urethritis

60
Q

most commonly caused by chlamydia trachomatis

- more serous discharge/no discharge

A

Non-gonococcal urethritis

61
Q

What do the A-C, D-K, and L1-3 serotypes of non-gonococcal infection cause?

A
  • A-C: leading cause of blindness in the world, cause trachoma
  • D-K: GU track one, cause urethritis, pelvic inflammatory disease, ectopic pregnancy neonatal pneumonia, neonatal conjunctivitis
  • L1-3: lymphogranuloma venereum (painless lesion)
62
Q

What is urethritis associated with in men and women?

A 
women = cystitis
men = prostatitis
63
Q

painful, small, red inglammatory lesion of the external urethral meatus in (older) females

  • granulation tissue with friable mucosa covering
  • bleed easily due to ulceration
  • excision is curative
A

urethral caruncle

64
Q

proximal urethra: slow urothelial differentiation, just like in the bladder
distal urethra; more commonly squamous cell carcinomas

A

primary carcinoma of the urethra

65
Q

what are uncommon in the urethra, but occur in women if they do appear?

A

adenocarcinomas of the urethra

66
Q

urethral opening on the ventral aspect of the penis (more common)

A

hypospadias

67
Q

urethral opening on the dorsal surface of the penis (less common)

A

epispadias

68
Q

what are both epi and hypospadias associated with?

A

abnormalities of normal descent of the testes and comorbid with other malformations of the urinary tract

69
Q

prepuce orifice is too small to permit normal retraction

- developmental causes are less common than secondary to inflammation that cause scarring of the preputial ring

A

phimosis

70
Q

infection of the glans and prepuce by non-specific organisms (not STD’s)

  • candida albicans
  • anaerobic bacteria
  • garnerella
  • pyogenic bacteria

** poor hygeine in uncircumcised males -> inflammatory scarring -> phimosis

A

balanoposthitis

71
Q

benign sexually transmitted wart

  • HPV 6>11
  • single or multiple sessile or pedunculated, red papillary excrescences
  • recurrant after incision, rarely becomes malignant
  • often at coronal sulcus or inner prepuce
  • can present with acanthosis and loilocytosis
A

Condyloma acuminata (penile tumor)

72
Q

What are the 5 malignant tumors of the penis listed?

A
  1. carcinoma In Situ
  2. Bowen Disease
  3. Bowen Disease
  4. Bowenoid Papulosis
  5. Squamous cell carcinoma of the penis
73
Q

What HPV strains are strongly associated with carcinoma in situ?

A

6, 11, 16 and 18

74
Q

males or female >35 years old***

  • solitary** thickened, gray-white plaques over penile shaft (or red shiny lesions) on the glands and prepuce
  • epidermis is hyerproliferative, lots of mitoses, some atypia, dysplasia, no orderly maturation
  • hyperchromatic nuclei
  • intact basement membrane, but 10% can transform into squamous cell carcinoma in approximately 10% of patients over a span of many years
A

Bowen disease

75
Q

multiple, pigmented papular lesions on external genitalia

  • typically younger, sexually active
  • multiple** reddish-brown papular lesions
  • frequently spontaneously regress
  • rarely evolve to invasive carcinoma
A

Bowenoid Papulosis

76
Q

associated with poor genital hygiene and high risk HPV infection

  • 40-70 years old
  • higher prevalence in Asia, Africa and south America than US -> d/t lack of circumcision
  • smoking increases risk
A

Squamous cell carcinoma of the penis

77
Q

what is the flat pattern morphology of squamous cell carcinoma of the penis?

A

epithelial thickening on the glans or inner surface of the prepuce
- progresses to ulcerated papule

78
Q

what is the papillary morphology of squamous cell carcinoma of the penis?

A

epithelial thickening with graying and fissuring of the mucosal surface
- stimulate condyloma acuminata and may produce a cauliflower-like fungating mass

79
Q

invasive squamous cell carcinoma of the penis

  • slow growing and locally-invasive
  • often present for a year or more before it is brought to medical attention
  • not painful until they secondarily ulcerate and become infected
  • metastases to regional (inguinal and iliac) LN’s
A

squamous cell carcinoma of the penis

80
Q

completely asymptomatic, comes to attention when the scrotal sac is discovered to be empty by the pt (or examining physician)

  • concominant inguinal hernia accompanies undescended testis in 10-20% of cases
  • greater risk of developing testicular cancer with undescended testes
A

cryptorchidism

81
Q

middle age pt, painless or moderately tender testicular mass of sudden onset sometimes associated with fever

  • granulomas are restricted to spermatic tubules
  • found diffusely throughout the testes
A

granulomatous (autoimmune) orchitis

82
Q

retrograde expansion of infection from posterior urethra to prostate, seminal vesicles and epididymis

  • ascending infection
  • from neglected gonococcal infection
  • if left untreated can lead to testis suppurative orchitis
A

gonorrhea

83
Q

systemic viral infection

  • common affects children, though testicular involvement at that age
  • 20-30% of post-pubertal men who are infected present with orchitis 1 week after inflammation of parotid glands
A

mumps

84
Q

congenital or acquired- testes involved first, epididymus is commonly spared

  • two morphologic patterns:
    1. nodular gummas
    2. diffuse interstitial inflammation (histologic hallmark syphilitic infection)
A

syphilis

CPR II Exam 2 (5 decks)

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