L15- Urinary Tract Pathology Flashcards
Name the structural/congenital lesions of urinary tract that we discuss.
Bladder - Diverticuli, extrophy, vesicoureteral reflux
Ureter - double/bifid ureter and uteropelvic junction anomalies
What are diverticuli? What happens in congenital and what happens in acquired?
Complications?
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
What the heck is exstrophy? What happens there?
Developmental failure of anterior wall of abdomen and so bladder communicates to exterior world
Complications - infection, ulceration, increased risk of adenocarcinoma
Tx surgery
What is Vesicoureteral Reflux? What happens in congenital vs Acquired? Complciations?
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
What happens w/ Bifid Ureter?
no clinical significance
What is Ureteropelvic junction obstruction? Who gets it?
*MOST COMMON CAUSE OF HYDRONEPHROSIS IN CHILDREN
Men > Women
congenital
What are the different types of cystitis?
UTI/Infectious
Interstitial
Malakoplakia
Polypoid
What are symptoms of cystitis? Cuases?
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
What do yo usee grossly and microscopically in cystits?
Grossly - red, hyperemia, exudates, hemorrhage, ulcerations
Micro - inflammatoyr cells, edema, reactive epithelial changes
PMNs, lymphocytes, plasma cells
Follicular cystits
What is interstitial cystitis? Who gets it? What happens?
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
What is Malacoplakia cystitis? What do yo usee grossly and on histology?
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
What is Polypoid Cystits? What causes it? What do you see?
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
What are the malignant and benign neoplasms of Urinary tract?
Malignant:
Urothelial Carcinoma - 90%
Squamous cell carconima - Shistosomiasis
Adenocarcinoma
Small cell
Sarcomas
Benign
- Papilloma
- Benign spindle cell tumor
Uncertain PUNLMP
What do you remove the bladder in bladder cancer?
Decision to remove bladder based on invasion into muscle cell layer
Urothelial Carcinoma - who gets it? Risk Factors?
What happens w/ these tumors ?
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!
What are the “Flat Lesions” and their progression in Urothelial carcinoma?
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
What are the papillary lesions in urothelial carcinoma and how do they progress?
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
What do you see in invasive urothelial carcinoma?
Cells penetrate BM and LP and see irregular nests of carcinoma invading stroma and causing desmoplasia - fibroblastic proliferation in disorganized fashion
How is urothelial carcinoma staged and what is the bid difference to note prognostically?
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
Urothelial carcinoma treatment?
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
Diagnosing Urothelial Carcinoma?
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
What causes Squamous cell carcinoma? What do you see in that?
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
What is Rhabdomyosarcoma? Who gets it? Dx?
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
