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Pathology > Lower Urinary Tract > Flashcards

Lower Urinary Tract Flashcards

1
Q

how many layers of cells are in contract and dilated states of urinary bladder?

A

Contacted = 5-7 layers
Dilated = 2-4 layers

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2
Q

What are the 7 types of diseases of lower urinary tract?

A

Congenital and acquired anomalies, Inflammation, Metaplastic lesions, Urethral obstructive lesions, urethral caruncle, fibroepithelial polyp, & neoplasms

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3
Q

What are the 8 congenital and acquired lower urinary tract diseases?

A

Ureteropelvic junction obstruction
Ureteral diverticulum
Congenital bladder diverticulum
Acquired bladder diverticulum
Acquired urethral diverticulum
Bladder exstrophy
Vesico-ureteral junction reflex
Urachal anomalies

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4
Q

what is the most common cause of hydronephrosis in children & infants?

A

ureteropelvic junction obstruction

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5
Q

What is the cause of Ureteropelvic Junction Obstruction?

A

abnormal organization of smooth muscle bundles or excess stromal deposition of collagen at the UPJ

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6
Q

In congenital and adult cases, what is the usual presentation of UPJ?

A

congenital = bilateral; common in males
Adults = unilateral; common in females

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7
Q

What congenital disease of the lower urinary tract has a saccular outpouchings along the ureter wall where it gives rise to recurrent infections?

A

Ureteral diverticulum

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8
Q

What congenital disease of the LUT has saccular outpouchings due to focal weakness in the wall?

A

Congenital bladder diverticulum

failure in devt of bladder wall during fetal devt

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9
Q

What congenital disease of the LUT has saccular outpuching of the bladder wall due to INC intravesicular pressure 2ndary to obstruction of urine outflow?

A

Acquired bladder diverticulum

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10
Q

What is the gross finding in acquired bladder diverticulum?

A

thickening or hypertrophy of bladder wall

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11
Q

What are the clinical significance of seeing acquired bladder diverticulum?

A

could indicate:
Urine stasis, Infection, Stone formation, & Increased risk of developing carcinoma

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12
Q

What kind of congenital LUT disease has a pouch that forms along the urethra where it can be filled with urine & lead to infections?

A

Acquired urethral diverticulum

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13
Q

What are the clinical manifestations of acquired urethral diverticulum? Possible cause of this disease?

A

painful vaginal mass
cause –> repeated infections in a periurethral gland that results in blockage –> blocked gland bursts into the urethra

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14
Q

What kind of congenital LUT disease has failure of both abdominal wall and bladder wall to CLOSE during fetal devt?

A

Bladder exstrophy

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15
Q

How does Bladder Exstrophy present?

A

Protrusion of the bladder wall through the lower abdominal wall

Direct communication betw bladder & abdominal surface (exposed bladder)

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16
Q

What could Extrosphy indicate?

A

Adenocarcinoma in the bladder remnant

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17
Q

What kind of lower UT is the most common and serious congenital anomaly and is caused by a congenital abnormality at the UTEROVESCIAL JUNCTION

A

Vesico-Ureteral Junction Reflux

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18
Q

What happens to the bladder during Vesico-Ureteral Junction reflux?

A

Urine flows back to the kidneys (Faulty malfuncitoning valve)

causes UTI, ascending pyelonephritis, & Hydronephrosis

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19
Q

What structure connects the fetal bladder with the allantois?

A

Urachal canal

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20
Q

What congenital LUT disease has incomplete obliteration of the urachus?

A

Urachal anomalies

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21
Q

What are the 4 types of congenital anomalies?

A

Patent urachus
Umbilical-urachal sinus
Vesicourachal diverticulum
Urachal cyst

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22
Q

What is the most common urachal abnormality where there is a communication formed betw THE BLADDER & UMBILICUS as a fistulous urinary tract? What happens bcos of this?

A

Patent urachus
-> Total failure to involute

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23
Q

What kind of urachal abnormality has urachus open into the umbilicus and drainage from the umbilicus causing partial involution?

A

Umbilicus-urachal sinus

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24
Q

What kind of urachal abnormality has wide patent opening into the bladder partial involution?

A

Vesicoureachal diverticulum

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25
Q

What kind of urachal abnormality has urachal cyst formed with urothelial/metaplastic glandular epithelium formed?

A

Urachal cyst –> can become adenocarcinoma

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26
Q

What are the diff inflammatory conditions of LUT?

A

Acute & Chronic Cystitis

Other forms of Cystitis: Polypoid cystitis, hemorrhagic cystitis

Special types of cystitis: Malakoplakia of the urinary bladder, Interstitial cystitis

Urethritis

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27
Q

What is the route of infection in acute & chronic cystitis?

A

Ascending route

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28
Q

What are the predisposing factors for cystitis?

A

Bladder calculi
Urinary obstruction
DM
Instrumentation
Immune deficiency

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29
Q

What are the triad of symptoms of cystitis?

A

Urinary frequency (INC)
Lower abdominal pain
Dysuria

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30
Q

What are the 2 special forms of cystitis?

A

Eosinophilic cystitis
Follicular cystitis

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31
Q

What condition is follicular cystitis associated with?

A

long-standing infection
lymhoid follicles in lamina propria are affected

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32
Q

what are other forms of cystitis? what makes them be categorized as ‘other’?

A

these are from Iatrogenic causes (radiation cystitis, hemorrhagic cystitis from chemo, & polypoid cystitis)

Polypoid cystitis
Hemorrhagic cystitis

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33
Q

What is the cause of Polypoid cystitis?

A

irritation of bladder mucosa reulting to instrumentation including indwelling catheters

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34
Q

What is the histological feature of Polypoid cysittis?

A

Urothelium = broad bulbous polypoid projections as a result of marked submucosal edema

MAY BE MISTAKEN FOR PAPILLARY UROTHELIAL CARICNOMA

35
Q

What other types of cystitis is associated with the cytotoxic SE of antitumor therapy?

A

Hemorrhagic cystitis

36
Q

What drug can induce hemorrhagic cystitis?

A

Cyclophosphamide –> excretes Acrolein (urotoxic)

37
Q

What are the 2 special types of cystitis?

A

Malakiplakia of the urinary bladder
Interstitial cystitis

38
Q

What special type of cystitis where there is a defect in phagocytic & degradative function of macrophages?

A

Malakoplakia of the urinary bladder

39
Q

What is the gross pathologic finding of Malakiplakia of the urinary bladder?

A

Yellow soft plaques on the surface of the urinary bladder

40
Q

What is the histologic pathologic finding of Malakiplakia of the urinary bladder?

A

Abundant foamy histoicytes & Basophilic laminated targetoid sutrctures like Michaelis Gutmann bodies

41
Q

What are Michaelis-Gutmann bodies?

A

Laminated targetoid structures formed by CaPO4 deposition on bacteria/their fragments

42
Q

What special type of cystitis is aka chronic pelvic syndrome/Hunner’s cystitis due to an unknown cause?

A

Interstitial cystitis

43
Q

What are the clinical symptoms of Interstitial Cystitis?

A

Urinary frequency INC
Dysuria
Hematuria
Suprapubic pain –> FIbrosis of the muscular bladder wall

44
Q

What are Hunner’s ulcers/Hunner’s lesions/Hunner’s patches?

A

not ulcers in the usual sense but are distinctive areas of inflammation in the bladder wall that characterize the “classic” form of interstitial cystitis

45
Q

What is the histology of Interstitial cystitis?

A

Non specific edema, congestion, and nonspecific inflammatory infiltrates

dx is only made after other causes have been rules out (repeat urine c/s are all neg for bacte, fungi and viruses)

46
Q

What is a condition often accompanied by cystitis in women & prostitis in men?

A

Urethritis

47
Q

What are the 2 LUT metaplastic lesions?

A

Cystitis Glandularis Et Cystica
Squamous cell metaplasia

48
Q

What are Brunn nests in Cystitis Glandurlaris Et Cystica?

A

common lesions in the urinary bladder where clusters of urothelium lie under the surface mucosa

49
Q

What lesion in Cystitis Glandularis Et Cystica has this transformation of the centrla epithelium into cuboidal/columnar lining?

A

Cystitis glandularis

50
Q

What lesion in Cystitis Glandularis Et Cystica has cystic spaces filled with clear fluid lined by flattened urothelium?

A

Cystitis cystica

51
Q

What metaplastic lesion has pure SCC associated with chronic irritation & infection?

A

Squamous cell metaplasia

52
Q

What are the 2 types of ureteral obstructive lesions?

A

Extrinsic & Intrinsic lesions

53
Q

What are the intrinsic lesions of ureteral obstructive lesions?

A

Calculi
Stricture
Tumors
Blood clots
Neurogenic interruption of the neural pathways to the bladder

54
Q

What are the extrinsic lesions of ureteral obstructive lesions?

A

Pregnancy -> relaxation of SM
Periureteral fibrous scarring
Sclerosing Retroperitoneal fibrosis
Periureteral tumor extension

55
Q

What are the 3 conditions that can arise from intrinsic and extrinsic lesions of the ureter?

A

Hydrourter
Hyronephrosis
Pyelonephrosis

56
Q

What are other causes of ureter obstructive lesions?

A

Unilateral obstruction
Bilateral obstruction

57
Q

What LUT disease has fleshy outgrowings in th edistal urethral mucosa that has inflamed granulation & tissue covered by friable mucosa?

A

Urethral caruncle

58
Q

What are the causes of urethral caruncle?

A

Distal urethral prolapse
Estrogen withdrawal at menopause

59
Q

Where does Urethral caruncle originate from?

A

Posterior lip of the urethra

60
Q

What tumor-like lesion in the LUT occurs in children and is composed of loose vascularized CT overlaid by urothelium?

A

Fibroepithelial polyp

61
Q

Where can urothelial tumors arise?

A

Pelvis, ureter, bladder, and distal urethra (anywhere w/ ureothelium)

62
Q

What are the risk factors of urothelial cancer?

A

Cigarette smoking
Occupational exposure
Irradiation
Chronic abuse of peracetic containing analgesics
Chronic cystitis caused by S. haematobium

63
Q

What occupation hazard is found to be a bladder carcinogen?

A

Aromatic amines

64
Q

What genes play a part in the formation of urothelial tumors?

A

Inactivation of TP53 & RB tumor suppressor genes

65
Q

What are the urothelial tumor preursor lesions?

A

Non-invasive papillary tumor -> most common
Flat non-invasive carcinoma - aka Carcinoma in situ

66
Q

What is the diff betw benign urothelium & carcinoma in situ?

A

CISU = UMBRELLA CELL LAYER is generally lost
BU = lack of marked atypia of basal & intermediate cells

67
Q

What are the 4 morphologic patterns of Urothelial lesions?

A

papillary urothelial neoplasm, non-invasive
Invasive papillary carcinoma
Flat non-invasive carcinoma
Flat invasive carcinoma

68
Q

Are px whi have had papillary tumors of the urinary bladder at risk of developing invasive carcinoma?

A

yes, these morphological patterns depend on how it grows

69
Q

What is the morphological pattern of urothelial lesion that grows SLENDER, FINGER-LIKE projections towards the centers of the bladdeR?

A

Papillary urothelial neoplasm, non-invasive

70
Q

What is the morphological pattern of urothelial lesion that frequently multiplies & the most common form of urothelial lesion?

A

Invasive papillary carcinoma

71
Q

What is the morphological pattern of urothelial lesion that grows flat and there’s a precursor lesion & invasion in the lamina propria and muscularis (THICK)?

A

flat invasive carcinoma

non-invasive if di aabot ng lamina propria & muscularis

72
Q

What are the 3 important gross features of urothelial lesions?

A

Flat lesions
Papillary tumors
Papillary Exophytic cauliflower-like large tumors

73
Q

What urothelial lesion is classified as carcinoma in situ?

A

flat lesions

74
Q

What urothelial lesion is seen as a small exophytic tumor that project into the lumen as wart-like papillary outgrowths?

A

Papillary tumors

75
Q

What urothelial lesion is seen as an exophytic cauliflower-like large tumors?

A

Papillary exophytic cauliflower-like large tumors

76
Q

What is the classification of non-invasive papillary urothelial tumors?

A
  1. Papilloma
  2. Papillary Urothelial Neoplasm of Low Malignant Potential
  3. Non-invasive low grade papillary
  4. Non-invasive high grade papillary
77
Q

What is a type of Urothelial neoplasm that has a thicker urothelium w/ INC density of cells?

A

Punlump

78
Q

What is the diff betw non-invasive LOW & HIGH grade papillary urothelial carcinoma?

A

LOW - urothelial lining displays MINIMAL cytologic atypia, irrespective of thickness

HIGH = marked cytologic and architectural atypia
-> highest risk of muscle invasion

79
Q

What are the 4 non-invasive papillary urothelial tumors? From these 4, what are those at risk of muscl e invasion?

A

Urothelial Papilloma
Punlump
Non-invasive LOW grade papillary urothelial carcinoma = MODERATE risk of muscle invasion
Non-invasive HIGH grade papillary urothelial carcinoma = HIGHEST GRADE of muscle invasion

80
Q

What is an invasive urothelial carcinoma?

A

it has penetrated the basement mebrane, invaded lamina propria/deeper into the muscularis propria

Grade & Depth of invasion = best determinants of prognosis

81
Q

What is the gross feature of Invasive urothelial carcinoma?

A

Subtle bladder wall thickening to obvious exophytic mass

82
Q

What is the histologic feature of invasive urothelial carcinoma?

A

high grade nuclear and architectural atypia
invasion of the lamina propria and muscularis propria
frequent mitosis

83
Q

What are the clinical features of urothelial tumors?

A

Painless gross hematuria

84
Q

How do we stage bladder cancer using TNM?

A

Ta = non-invasive papillary
Tis = carcinoma in-situ, flat
T1 = lamina propria
T2 = Muscularis propria
T3a = microscopic extension beyond the UB wall
T3b = gross extension beyond the UB wall
T4 = invades adjacent structures

Pathology (8 decks)

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