L60 Flashcards
What is a diverticuli + associated complications?
Outpouching of bladder wall Complications: 1. Urinary statis -> infection + stones 2. Reflux 3. Malignancy
Describe congenital vs acquired diverticuli
Congenital: didn’t develop normal muscle in bladder wall, single
vs
Acquired: obstruction (prostate enlargement) -> muscle thickening, multiple
What is exstrophy? Complications + surg
Fail to develop ant wall abdomen
Bladder connects to exterior
Complications: infection (duh), adenocarcinoma
Treat: surg
What is vesi-cou-reteral reflux? Congenital vs acquired causes
Reflux of urine from bladder into ureters
Congenital: shorten the part of the ureter in the bladder (doesn’t compress when you pee)
vs
Acquired: bladder atony aka no bladder tone to create urine directionality (spinal cord injury)
Complication of vesicoureteral reflux
Pyelo - duh
Renal scarring
3 structural abnormalities of the ureter
Double
Bifid
Ureteropelvic jxn (where ureter connects to the kidney) obstruction - congenital, *most common cause hydronephrosis in kids
What is cystitis? Common causes
Bladder infection Bacteria: EColi, enterobacteria Fungal: IC pts Schistosoma haematobium Anti-cancer drugs/radiation
Gross vs microscopic appearance of cystitis
Red bladder
Micro: inflam cells in bladder epithelium
Acute = neutrophils
Chronic = lymphocytes + plasma cells, maybe cysts of these cells
What type of disease is interstitial cystitis? M vs W. Treat?
Chronic cystitis
Freq pee, nocturia, urgency, pubic pain or pressure relieved by peeing
W > M
Difficult to treat
Histo for interstitial cystitis
Edema in submucosa
Maybe punctate hemorrhages
Hunner’s ulcer (classic)
What is malacoplakia?
Mass lesion in bladder or kidney: raised yellow plaques
Due to chronic infection - EColi maybe proteus
Aka common in IC pts
Malacoplakia histo
Foamy macrophages (lipid inside) Michaelis Gutmann bodies = Ca phosphate inclusions
What is polypoid cystitis?
Inflam lesion of bladder due to irritation (indwelling catheter)
Don’t confuse for urothelial carcinoma
Polypoid cystitis histo
Broad, edema polypoid projections
Vs urothelial neoplasm = narrow
Urothelial cancer:
M vs W
Name top risk factors
M > W SMOKING!!!! Aniline dyes Chronic irritation: chronic cystitis, diverticula, parasites Analgesic abuse
How does urothelial carcinoma recur?
Original resected tumor doesn’t come back
The entire urothelium has increased chance of cancer
Different tumor, new location
What are the types of flat urothelial neoplasms lesions you might see?
Flat lesions are either benign (low grade) or carcinoma in situ (high grade + confined to mucosa)
If goes past mucosa = invasive carcinoma
What are the types of papillary urothelial neoplasms?
Papilloma = no chance recur, young pts
PUNLMP
Papillary carcinoma, low or high grade
Histo of papillary urothelial cancers
Thin papillae (vs polypoid cystits) W/ fibrovasc cores
What is a PUNLMP? Histo
Papillary urothelial neoplasm of low malignant potential
- Thick epithelium w/o atypia
- No invasion
- Potential to recur
Histo of low grade papillary urothelial carcinoma
Uniform nuclei
Scattered mitoses
Recur commonly but rarely invade
Histo high grade papillary urothelial carcinoma
Many mitoses
Disordered cells
Dyscohesive cells
Invade stroma, mets possible
Histo invasive urothelial carcinoma
Papillary or flat - once invade grouped together as invasive
Penetrate basement membrane -> into LP
See stromal nests
How do you stage urothelial cancer?
Invasion and if mets
Test q: the difference between which 2 stages of urothelial cancer determines treatment and thus prognosis?
T1 = invade LP
T2 = invade MP, here you’re going a partial or complete cystectomy
After T2 - all bad, treat same as T2
Treat urothelial cancer
Resect: T1 vs T2
Topical: BCG or intravesicle chemo
Systemic chemo for high stage
Symptoms of urothelial cancer
Hematuria
“Elderly male w/ 1 episode hematuria”
Dx urothelial cancer
Urine cytology + cytoscopy
Both will find any evidence of flat or pap tumors
What cancer does schistosoma hematobium give you?
Bladder SCC
Look for keratin pearls or eggs
Bladder tumor in kids
Rhabdo-myo-sarcoma
