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Kidneys > L15- Urinary Tract Pathology > Flashcards

L15- Urinary Tract Pathology Flashcards

1
Q

Name the structural/congenital lesions of urinary tract that we discuss.

A

Bladder - Diverticuli, extrophy, vesicoureteral reflux

Ureter - double/bifid ureter and uteropelvic junction anomalies

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2
Q

What are diverticuli? What happens in congenital and what happens in acquired?

Complications?

A

Diverticuli = outpouching of bladder wall

Congenital - focal failure of development of normal muscle, urinary tract obstruction in fetal development

Acquired - secondary to obstruction, marked muscle thickening of bladder wall (2 to prostatic enlargement) or multiple w/ narrow necks located bw hypertrophied muscle (trabeculated mucosa)

Complications: Urinary stasis, infection, stones, reflux, cancer

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3
Q

What the heck is exstrophy? What happens there?

A

Developmental failure of anterior wall of abdomen and so bladder communicates to exterior world

Complications - infection, ulceration, increased risk of adenocarcinoma

Tx surgery

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4
Q

What is Vesicoureteral Reflux? What happens in congenital vs Acquired? Complciations?

A

Most common and most serious anomaly

Definition - incompetence of vesicoureteral valve

Congenital - absence or shortening of intravesicle portion that prevents compression of ureter during mictruation

Acquired - Atony of bladder SCI

complications - Pyelonephritis and renal scarring

See picture

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5
Q

What happens w/ Bifid Ureter?

A

no clinical significance

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6
Q

What is Ureteropelvic junction obstruction? Who gets it?

A

*MOST COMMON CAUSE OF HYDRONEPHROSIS IN CHILDREN

Men > Women

congenital

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7
Q

What are the different types of cystitis?

A

UTI/Infectious

Interstitial

Malakoplakia

Polypoid

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8
Q

What are symptoms of cystitis? Cuases?

A

Symptoms - urinary frequency, suprapubic pain, dysuria

Can get systemic symptoms like fever, chills, malaise (Esp if spreads to pyelonephritis)

Causes:

bacterial - Majority!!! E.Coli

fungal - immunosuppresses

Parasitic - SCHISTOSOMIASIS - Squamous cell carcinoma

Anti-Cancer Treatments - Cyclophosphamide can cause hemorrhagic cystitis

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9
Q

What do yo usee grossly and microscopically in cystits?

A

Grossly - red, hyperemia, exudates, hemorrhage, ulcerations

Micro - inflammatoyr cells, edema, reactive epithelial changes

PMNs, lymphocytes, plasma cells

Follicular cystits

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10
Q

What is interstitial cystitis? Who gets it? What happens?

A

Form of chronic cystitis w/ unknown etiology

(Urine is sterile!!! Many pts have Autoimmune disease)

Women get it more than men

Symptoms - frequency, notcutura, suprapubic pressure, pelvic pain on bladder filling that is RELIEVED by voiding

Histology: Chronic inflammation, edema, ulceration and fibrosis, microhemorrhages

Hunner’s Ulcer

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11
Q

What is Malacoplakia cystitis? What do yo usee grossly and on histology?

A

Mass lesion from chronic bacterial infection like Ecoli or Proteus, seen in immunosuppressed transplant patients

Grossly: Yellow raised mucosal plaques

Histology: Foamy Macrophages, Giant cells

Michaelis Gutmann Bodies!!! = target appearance and non-nuclear inclusions of calcium phosphate in foamy macrophages

see pics

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12
Q

What is Polypoid Cystits? What causes it? What do you see?

A

Polypoid inflammatory lesion of bladder - THICK stromal core (differnt from Papillary Polyp)

Results from chronic irritation - most common is indwelling catheter

BROAD Bulbous polypoid projections w/ submucosal edema

Broad, Fat core w/ epithelium lining and lots of inflam cells

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13
Q

What are the malignant and benign neoplasms of Urinary tract?

A

Malignant:

Urothelial Carcinoma - 90%

Squamous cell carconima - Shistosomiasis

Adenocarcinoma

Small cell

Sarcomas

Benign

  • Papilloma
  • Benign spindle cell tumor

Uncertain PUNLMP

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14
Q

What do you remove the bladder in bladder cancer?

A

Decision to remove bladder based on invasion into muscle cell layer

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15
Q

Urothelial Carcinoma - who gets it? Risk Factors?

What happens w/ these tumors ?

A

Male > Female and pts between 50-80 yo

RF - SMOKING, aniline dyes, chronic irritation (chronic cystitis, calculi, divertculi) or Analgesic abuse nephropathy

Tumors tend to RECUR!~!!! Fild effect!

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16
Q

What are the “Flat Lesions” and their progression in Urothelial carcinoma?

A

Hyperplasia - thickening but cells are bland

Atypia and Dysplasia

Carcinoma In-Situ - flat, high grade, confined to mucosa and precursor to invasive –> cells atypical w/ large nuclei, mitosis, no umbrella cells

17
Q

What are the papillary lesions in urothelial carcinoma and how do they progress?

A

Papilloma - rare, benign, young patients, does NOT recur, delicate fibrovascular stalks w/ normal urothelium

PUNLMP = papillary Urothelial Neoplasm of low Maligntant potential - Thickeneded epithelium BUT potential for recurrence and warning for future!!

Papillary Carcinoma - low grade - Irregular surface grows into lumen and must biopsy villi to enlarged nuclei, scatterefd mitosis, some atypia

Papillary CArcinoma - high grade- analogous to CIS, Disorderly arrangement w/ irregularly clustered cells, fused papillae, discohesive single cells fall off into urine and Fibrovascular stalks in center

18
Q

What do you see in invasive urothelial carcinoma?

A

Cells penetrate BM and LP and see irregular nests of carcinoma invading stroma and causing desmoplasia - fibroblastic proliferation in disorganized fashion

19
Q

How is urothelial carcinoma staged and what is the bid difference to note prognostically?

A

Based on depth of invasion and presence of Mets (see picture)

*BIG DIFFERENCE btween T1 and T2 where LP and Muscularis invasions bc once into muscle then cystectomy vs local therapy

20
Q

Urothelial carcinoma treatment?

A

Resection: TURBT (transurethral scoop it out for non-invasive or LP invasion) or Cystectomy (for partial or radical when have muscularis invason)

Topical: Bacille Calmetter Guerin (BCG) TB causes granulomatous reaction, Intravesicle CTX or systemic CTX

21
Q

Diagnosing Urothelial Carcinoma?

A

Symptoms - Painless hematuria (esp in elderly man MUST do cancer workup)

Urine Cytology - good for high grade tumors

Cystoscopy - good for papillary lesions, lower grade, less sensitive for CIS

22
Q

What causes Squamous cell carcinoma? What do you see in that?

A

Schistosoma Hmeatboium infections - Middle East/Egypt!

Prolonged chronic cystitis leads to squamous metaplasia and keratinization

LP contains parasites w/ intense eosinophilic infiltrates and Schistosomes w/ posterior (vs lateral) spine

23
Q

What is Rhabdomyosarcoma? Who gets it? Dx?

A

Most common bladder tumor in children!

Mesenchymal tumor derived from muscle layer

grows rapidly and forms bulky mass that protrudes into lumen

Cross-striations in cell -center diagnostic of skeletal muscle differentiation

Kidneys (13 decks)

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