LUT Flashcards
normal epithelium thickness from calices to urethra
4-8
normal lining epithelium
transitional or urothelial epithelium
anatomical layers of ureter
transitional epithelium with umbrella cells
lamina propria
muscularis
adventitia
most likely places to have ureteral constriction just from gross anatomy alone
uteropelvic junction in the renal hilum
pelvic brim near the bifurcation of iliacarteries
as it enters the bladder in the ureterovesical valve
interchangeably called the lamina propria
bladder submucosa
where would the membranous urethra be?
passes through the external urethral sphincter, narrowest part
where would the spongy urethra be?
aka penile urethra
along the length of the penis on its ventral surface
there are very few _____diseases but my ____ of the LUT
degenerative
anomalies
congenital anomalies of the ureter
double and bifid ureters
uretero-pelvic junction obstruction
diverticula
hydroureter
totally distinct double renal pelves or with a large kidney having partially bifid pelvis terminating in separate ureters
double and bifid ureters
results in hydronephrosis
ureteropelvic obstruction
ureteropelvic obstruction usually affects
children esp boys
*in adults, women, unilateral
pathogenesis of UPJ obstruction
disorganized proliferation of smooth muscles at the UPJ and excess stromal deposition of collagen between smooth muscle bundles
or
excess stromal deposition of collagen between smooth muscle bundles
or rarely due
to congenitally extrinsic compression bu polar renal vessels
congenital or acquired saccular outpouching of the ureteral wall
diverticula
ureter diverticula are prone to have
pockets of stasis
secondary infection
marked dilatation of the ureter with accompanying hydronephrosis
hydroureter
massive enlargement of ureter due to functional defect in the ureteral muscle
megaloureter
usual cause of ureteritis
inflammation of the entire LUT secondary to obstruction
accumulation of lymphocytes forming germinal centers in the subepithelial region that may cause slight elevations of the mucosa and produce a fine granular mucosal surface
ureteritis follicularis
ureteral counterpart of cystitis cystica
little mucosal cyst line by columnar epithelium not transitional
ureteritis cystica
not clinicallly significant in obstructive lesions
ureteral dilatation
obstructive lesions give rise to
hydroureter
hydronephrosis
sometimes pyelonephritis
unilateral obstruction typically results from
proximal cause
bilateral obstruction arises fro
distal causes such as nodular hyperplasia of the prostate
intrinsic types of obstruction
calculi strictures tumors blood clots neurogenic
extrinsic types of obstruction
pregnancy
periureteral inflammation
endometriosis
tumors
Of renal origin
calculi
congenital or acquired cause of obstruction
strictures
blood clots come frome
massive hematuria from renal calculi, tumors, or papillary necrosis
uncommon cause of ureteral narrowing characterized by a fibrous proliferative inflammatory process encasing the retoperitoneal structures causing hydronephrosis
sclerosing retroperitoneal fibrosis
sclerosing retroperitoneal fibrosis occurs
middle to late age
microscopic features of sclerosing retroperitoneal fibrosis
prominent infiltrate of lymphocyte, often with germinal centers, plasma cells, and eosinophils
treatment for sclerosing retroperitoneal fibrosis
surgical extrication of ureters from the surrounding fibrous tissue aka ureterolysis
70% cause of sclerosing retroperitoneal fibrosis
idiopathic
general retroperitonal fibrosis
ormond disease
drugs causing sclerosing retroperitoneal fibrosis
ergot derivatives
beta blockers
retroperitoneal inflammatory conditions causingsclerosing retroperitoneal fibrosis
vasculitis
diverticulitis
Chron’s disease
benign tumors of the ureters originate from the
mesenchyme
often in children
tumorlike lesion that grossly presents as a small mass projecting into the lumen
fibroepithelial polyp
fibroepithelial polyp is composed of
loose vascularized CT mass lying beneath the mucosea
blood vessels are dilated
localized mass consisting of spindle-shaped lesions
leiomyoma
majority of malignant ureteral tumors are
urothelial carcinomas
malignant ureteral tumors resemble those arising from
renal pelives
calyces
bladder
malignant ureteral tumors happen
at the 6-7th decade of life
urethelial carcinoma aka
transitional cell carcinoma
gross TCC
irregular, exophytic lesion
histo TCC
abnormal capillary proliferation
dilated and obstructed ureteral lumen
in the lower urinary tract all of the papillary tumors are
TRANSITIONAL or urothelial in origin
not adenoca
congenital anomalies of the urinary bladder
diverticula exstrophy vesicoureteral reflux persisten urachus fistulas
pouchlike evagination of the bladder wall
diverticula
congenital form of diverticula cause
focal failure of development of the normal musculature or obstruction during development
acquired form - more common- cause
result of increased intrevesical pressure often seen in prostatic enlargement by hyperplasia or neoplasia
clinically significant diverticula constitute sites of urinary stasis resulting to
infection
formation of bladder calculi
developmental failure in the anterior wall of the abdomen and the bladder
exstrophy
exposed bladder mucosa in exstrophy predispose to
glandular metaplasia
infection
arising in the bladder remnant, exstrophy increases risk of
adeno CA
prognosis of exstrophy
surgical tx ➡️long term survival
most common and serious anomaly in children
vesicoureteral reflux
VUR leads to
chronic pyelonephritis
hydronephrosis
canal that connects the fetal bladder with the allantois
urachus
totally patent urachus
fistulous urinary tract is created that connects the bladder with the umbilicus
only the central urachus persists giving rise to
urachal cysts
urachal cysts can lead to
glandular carcinomas
urachus proximal to umbilicus
urachal sinus
urachus proximal to bladder
urachal diverticulum
common etiologic agents of cysitis
E coli
Proteus
Klebsiella
Enterobacter
other forms of cystitis
TB
candida albicans, cryptococcus
schistosoma haematobium
viruses
clinical manifestations of cystitis
urinary frequency
hypogastric or lower abdominal pain
dysuria
good for urinary tract infections
cranberries
predisposing factors of cystitis
bladder calculi urinary obstruction DM instrumentation immune deficiency
nonspecific form of cystitis
hyperemia of the mucosa and edema of the stroma sometimes exudates
hemorrhagic cystitis cause
cytotoxic antitumor drugs- cyclophosphamide
adenovirus infection
aggregation of lymphocytes into lymphoid follicle within the bladder mucosa and underlying wall
follicular cystitis
typically represents nonspecific subacute inflammation
rarely a manifestation of a systemic allergic disorder
eosinophilic cystitis
resulting from irritation of bladder mucosa- long term catheterization
polypoid cystitis
interstitial cystitis aka
chronic pelvic pain syndrome
Hunner’s cystitis
clinnical manifestation of interstitial cystitis
intermittent of often severe suprapubic pain
urinary frequency
urgency
hematuria
dysuria with no evidence of bacterial infection
histo interstitial cystitis
fissures and punctate hemorrhages - glomerulations in the bladder mucosa after luminal distention
some patients in the late, classic, ulcerative phase of interstitial cystitis show morphologic features
chronic mucosal ulcers or Hunner’s ulcers
gross feature of malacoplakia
soft, yellow slightly raised mucosal plaques
histo malacoplakia
large foamy macrophages mixed with occasional multinucleated giant cells and interspersed lymphocytes
macrophages in malacoplakia
have abundant granular cytoplasm due to phagosomes stuffed with particulate and membranous debris of bacterial origin
defect in malacoplakia
dysfunctional phagocytosis of macrophages
malacoplakia occurs in
immunosuppressed patients
present within macrophages in malacoplakia resulting form deposition of calcium in enlarge lysosomes, seen better in PAS stain
Michaelis-Gutmann bodies
nests of urothelium grow downward into the lamina propria
Brunn nests
Brunn nests undergo transformation of their epithelial cells into cuboidal columnar epithelium
cystitis glandularis
Brunn nests undergo transformation into cystic spaces filled with clear fluid lined by flattened urothelium
cystitis cystica
a variant of cystitis glandularis with goblet cells and intestinal mucosa like lining
intestinal or colonic metaplasia
not associated with an increased risk of adenoCA
lesions showing extensive intestinal metaplasia
a response to schistosome infections of the bladder- bilharziasis
squamous metaplasia
about 95% of bladder tumors are of
epithelial origin
most common neoplasm
transitional cell carcinoma of the bladder
TCC of the bladder run from
gamut from the small benign lesions that may never recur to aggressive cancers associated with high risk of death
TCC of the bladder tend to be
multifocal
two primary precursor lesions of TCC bladder
non invasive papillary tumors
usually comes from subsequent hyperplasia of papillary urothelial cells with better prognosis
non invasive papillary tumor of the bladder
more aggressive TCC of the bladder
flat urothelial carcinoma or carcinomoa in situ
the general rule in urothelial tumors
all papillary tumors of the bladder are regarded as cancers or potentially cancer
most papillary tumors are
low grade
urothelial papilloma is a benign lesion usually seen in
younger px
urothelial papillomas are typically seen as
singular nodules that are attached to the mucosa
the core of the fingerlike papillae
has loose fibrovascular tissue covered with epithelial cells similar to transitional epithelium
histo of urothelial papilloma
uniform nuclei maintained polarity normal mitotic figures papilloma does not extend 7 layers rapidly proliferating
same as urothelial papilloma but exceeds 7 layers (10) with rare mitotic figures
papillary urothelial neoplasm of low malignant potential
papillary urothelial neoplasm of low malignant potential prognosis
low rate of recurrence
minimal but definite signs of nuclear atypia that displays scattered hyperchromatic nuclei, infrequent mitotic figures that are found at the base , mild nuclear size and shape variations
low grade papillary urothelial carcinomas
dycohesive large hyperchromatic nuclei
frequent mitotic figures
invades the muscular layer
high grade papillary urothelial carcinoma
carcinoma grossly seen as reddening and thickening of mucosa
multifocal
ureters and urethra
flat urothelial CA
flat urothelial carcinoma leads to
invasive urothelial carcinoma
invasive urothelial CA is associated with
CIS
high grade papillary urothelial CA
invasive urothelial CA invades the
muscularis mucosae and propria
TCC epidemiology
50-60
male
genetic features of papillary tumors
deletions in chromosome 9
invasive, high grade tumors genetic feature
del in chromosome 17
risk factors of TCC
smoking arylamines exposure schistosoma chronic usage of analgesics cyclophosphamide radiation
Ta staging
non invasive papillary tumor
Tis staging
carcinoma in situ
T1 staging
lamina propria invaded
T2 staging
muscularis propria invaded
T 3a staging
microscopically beyond luminal wall
T3b staging
gross protuberance beyond the luminal wall
T4 staging
invasion of adjacent structures
most common cause of urinary bladder obstruction in women
cystocele
most common urinary bladder obstruction cause
prostate gland enlargement
clinical triad or arthritis, conjunctivits and urethritis
Reiter syndrome
urethritis classification
gonococcal
nongonococcal- E coli, Chlamydia, Mycoplasma
originate from the posterior lip of the urethra
fleshy outgrowths of distal urethral mucosa
small, red, painful mass
uretheral caruncle
cause of uretheral caruncle
distal uretheral prolapse
estrogen withdrawal
benign neoplasms of urethra
squamous
urothelial papillomas
inverted urothelial papillomas
condyloma
urothelial CA. within the proximal urethra show
urothelial
urothelial differentiation analogous to those within the bladder
urothelial CA distal urethra
squamous CA
