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Pathology > LUT > Flashcards

LUT Flashcards

0
Q

normal epithelium thickness from calices to urethra

A

4-8

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1
Q

normal lining epithelium

A

transitional or urothelial epithelium

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2
Q

anatomical layers of ureter

A

transitional epithelium with umbrella cells
lamina propria
muscularis
adventitia

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3
Q

most likely places to have ureteral constriction just from gross anatomy alone

A

uteropelvic junction in the renal hilum
pelvic brim near the bifurcation of iliacarteries
as it enters the bladder in the ureterovesical valve

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4
Q

interchangeably called the lamina propria

A

bladder submucosa

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5
Q

where would the membranous urethra be?

A

passes through the external urethral sphincter, narrowest part

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6
Q

where would the spongy urethra be?

A

aka penile urethra

along the length of the penis on its ventral surface

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7
Q

there are very few _____diseases but my ____ of the LUT

A

degenerative

anomalies

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8
Q

congenital anomalies of the ureter

A

double and bifid ureters
uretero-pelvic junction obstruction
diverticula
hydroureter

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9
Q

totally distinct double renal pelves or with a large kidney having partially bifid pelvis terminating in separate ureters

A

double and bifid ureters

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10
Q

results in hydronephrosis

A

ureteropelvic obstruction

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11
Q

ureteropelvic obstruction usually affects

A

children esp boys

*in adults, women, unilateral

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12
Q

pathogenesis of UPJ obstruction

A

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

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13
Q

congenital or acquired saccular outpouching of the ureteral wall

A

diverticula

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14
Q

ureter diverticula are prone to have

A

pockets of stasis

secondary infection

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15
Q

marked dilatation of the ureter with accompanying hydronephrosis

A

hydroureter

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16
Q

massive enlargement of ureter due to functional defect in the ureteral muscle

A

megaloureter

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17
Q

usual cause of ureteritis

A

inflammation of the entire LUT secondary to obstruction

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18
Q

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

A

ureteritis follicularis

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19
Q

ureteral counterpart of cystitis cystica

little mucosal cyst line by columnar epithelium not transitional

A

ureteritis cystica

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20
Q

not clinicallly significant in obstructive lesions

A

ureteral dilatation

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21
Q

obstructive lesions give rise to

A

hydroureter
hydronephrosis
sometimes pyelonephritis

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22
Q

unilateral obstruction typically results from

A

proximal cause

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23
Q

bilateral obstruction arises fro

A

distal causes such as nodular hyperplasia of the prostate

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24
Q

intrinsic types of obstruction

A 
calculi
strictures
tumors
blood clots
neurogenic
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25
Q

extrinsic types of obstruction

A

pregnancy
periureteral inflammation
endometriosis
tumors

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26
Q

Of renal origin

A

calculi

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27
Q

congenital or acquired cause of obstruction

A

strictures

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28
Q

blood clots come frome

A

massive hematuria from renal calculi, tumors, or papillary necrosis

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29
Q

uncommon cause of ureteral narrowing characterized by a fibrous proliferative inflammatory process encasing the retoperitoneal structures causing hydronephrosis

A

sclerosing retroperitoneal fibrosis

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30
Q

sclerosing retroperitoneal fibrosis occurs

A

middle to late age

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31
Q

microscopic features of sclerosing retroperitoneal fibrosis

A

prominent infiltrate of lymphocyte, often with germinal centers, plasma cells, and eosinophils

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32
Q

treatment for sclerosing retroperitoneal fibrosis

A

surgical extrication of ureters from the surrounding fibrous tissue aka ureterolysis

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33
Q

70% cause of sclerosing retroperitoneal fibrosis

A

idiopathic

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34
Q

general retroperitonal fibrosis

A

ormond disease

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35
Q

drugs causing sclerosing retroperitoneal fibrosis

A

ergot derivatives

beta blockers

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36
Q

retroperitoneal inflammatory conditions causingsclerosing retroperitoneal fibrosis

A

vasculitis
diverticulitis
Chron’s disease

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37
Q

benign tumors of the ureters originate from the

A

mesenchyme

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38
Q

often in children

tumorlike lesion that grossly presents as a small mass projecting into the lumen

A

fibroepithelial polyp

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39
Q

fibroepithelial polyp is composed of

A

loose vascularized CT mass lying beneath the mucosea

blood vessels are dilated

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40
Q

localized mass consisting of spindle-shaped lesions

A

leiomyoma

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41
Q

majority of malignant ureteral tumors are

A

urothelial carcinomas

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42
Q

malignant ureteral tumors resemble those arising from

A

renal pelives
calyces
bladder

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43
Q

malignant ureteral tumors happen

A

at the 6-7th decade of life

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44
Q

urethelial carcinoma aka

A

transitional cell carcinoma

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45
Q

gross TCC

A

irregular, exophytic lesion

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46
Q

histo TCC

A

abnormal capillary proliferation

dilated and obstructed ureteral lumen

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47
Q

in the lower urinary tract all of the papillary tumors are

A

TRANSITIONAL or urothelial in origin

not adenoca

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48
Q

congenital anomalies of the urinary bladder

A 
diverticula
exstrophy
vesicoureteral reflux
persisten urachus
fistulas
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49
Q

pouchlike evagination of the bladder wall

A

diverticula

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50
Q

congenital form of diverticula cause

A

focal failure of development of the normal musculature or obstruction during development

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51
Q

acquired form - more common- cause

A

result of increased intrevesical pressure often seen in prostatic enlargement by hyperplasia or neoplasia

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52
Q

clinically significant diverticula constitute sites of urinary stasis resulting to

A

infection

formation of bladder calculi

53
Q

developmental failure in the anterior wall of the abdomen and the bladder

A

exstrophy

54
Q

exposed bladder mucosa in exstrophy predispose to

A

glandular metaplasia

infection

55
Q

arising in the bladder remnant, exstrophy increases risk of

A

adeno CA

56
Q

prognosis of exstrophy

A

surgical tx ➡️long term survival

57
Q

most common and serious anomaly in children

A

vesicoureteral reflux

58
Q

VUR leads to

A

chronic pyelonephritis

hydronephrosis

59
Q

canal that connects the fetal bladder with the allantois

A

urachus

60
Q

totally patent urachus

A

fistulous urinary tract is created that connects the bladder with the umbilicus

61
Q

only the central urachus persists giving rise to

A

urachal cysts

62
Q

urachal cysts can lead to

A

glandular carcinomas

63
Q

urachus proximal to umbilicus

A

urachal sinus

64
Q

urachus proximal to bladder

A

urachal diverticulum

65
Q

common etiologic agents of cysitis

A

E coli
Proteus
Klebsiella
Enterobacter

66
Q

other forms of cystitis

A

TB
candida albicans, cryptococcus
schistosoma haematobium
viruses

67
Q

clinical manifestations of cystitis

A

urinary frequency
hypogastric or lower abdominal pain
dysuria

68
Q

good for urinary tract infections

A

cranberries

69
Q

predisposing factors of cystitis

A 
bladder calculi 
urinary obstruction
DM
instrumentation
immune deficiency
70
Q

nonspecific form of cystitis

A

hyperemia of the mucosa and edema of the stroma sometimes exudates

71
Q

hemorrhagic cystitis cause

A

cytotoxic antitumor drugs- cyclophosphamide

adenovirus infection

72
Q

aggregation of lymphocytes into lymphoid follicle within the bladder mucosa and underlying wall

A

follicular cystitis

73
Q

typically represents nonspecific subacute inflammation

rarely a manifestation of a systemic allergic disorder

A

eosinophilic cystitis

74
Q

resulting from irritation of bladder mucosa- long term catheterization

A

polypoid cystitis

75
Q

interstitial cystitis aka

A

chronic pelvic pain syndrome

Hunner’s cystitis

76
Q

clinnical manifestation of interstitial cystitis

A

intermittent of often severe suprapubic pain
urinary frequency
urgency
hematuria
dysuria with no evidence of bacterial infection

77
Q

histo interstitial cystitis

A

fissures and punctate hemorrhages - glomerulations in the bladder mucosa after luminal distention

78
Q

some patients in the late, classic, ulcerative phase of interstitial cystitis show morphologic features

A

chronic mucosal ulcers or Hunner’s ulcers

79
Q

gross feature of malacoplakia

A

soft, yellow slightly raised mucosal plaques

80
Q

histo malacoplakia

A

large foamy macrophages mixed with occasional multinucleated giant cells and interspersed lymphocytes

81
Q

macrophages in malacoplakia

A

have abundant granular cytoplasm due to phagosomes stuffed with particulate and membranous debris of bacterial origin

82
Q

defect in malacoplakia

A

dysfunctional phagocytosis of macrophages

83
Q

malacoplakia occurs in

A

immunosuppressed patients

84
Q

present within macrophages in malacoplakia resulting form deposition of calcium in enlarge lysosomes, seen better in PAS stain

A

Michaelis-Gutmann bodies

85
Q

nests of urothelium grow downward into the lamina propria

A

Brunn nests

86
Q

Brunn nests undergo transformation of their epithelial cells into cuboidal columnar epithelium

A

cystitis glandularis

87
Q

Brunn nests undergo transformation into cystic spaces filled with clear fluid lined by flattened urothelium

A

cystitis cystica

88
Q

a variant of cystitis glandularis with goblet cells and intestinal mucosa like lining

A

intestinal or colonic metaplasia

89
Q

not associated with an increased risk of adenoCA

A

lesions showing extensive intestinal metaplasia

90
Q

a response to schistosome infections of the bladder- bilharziasis

A

squamous metaplasia

91
Q

about 95% of bladder tumors are of

A

epithelial origin

92
Q

most common neoplasm

A

transitional cell carcinoma of the bladder

93
Q

TCC of the bladder run from

A

gamut from the small benign lesions that may never recur to aggressive cancers associated with high risk of death

94
Q

TCC of the bladder tend to be

A

multifocal

95
Q

two primary precursor lesions of TCC bladder

A

non invasive papillary tumors

96
Q

usually comes from subsequent hyperplasia of papillary urothelial cells with better prognosis

A

non invasive papillary tumor of the bladder

97
Q

more aggressive TCC of the bladder

A

flat urothelial carcinoma or carcinomoa in situ

98
Q

the general rule in urothelial tumors

A

all papillary tumors of the bladder are regarded as cancers or potentially cancer

99
Q

most papillary tumors are

A

low grade

100
Q

urothelial papilloma is a benign lesion usually seen in

A

younger px

101
Q

urothelial papillomas are typically seen as

A

singular nodules that are attached to the mucosa

102
Q

the core of the fingerlike papillae

A

has loose fibrovascular tissue covered with epithelial cells similar to transitional epithelium

103
Q

histo of urothelial papilloma

A 
uniform nuclei
maintained polarity
normal mitotic figures
papilloma does not extend 7 layers
rapidly proliferating
104
Q

same as urothelial papilloma but exceeds 7 layers (10) with rare mitotic figures

A

papillary urothelial neoplasm of low malignant potential

105
Q

papillary urothelial neoplasm of low malignant potential prognosis

A

low rate of recurrence

106
Q

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

A

low grade papillary urothelial carcinomas

107
Q

dycohesive large hyperchromatic nuclei
frequent mitotic figures
invades the muscular layer

A

high grade papillary urothelial carcinoma

108
Q

carcinoma grossly seen as reddening and thickening of mucosa
multifocal
ureters and urethra

A

flat urothelial CA

109
Q

flat urothelial carcinoma leads to

A

invasive urothelial carcinoma

110
Q

invasive urothelial CA is associated with

A

CIS

high grade papillary urothelial CA

111
Q

invasive urothelial CA invades the

A

muscularis mucosae and propria

112
Q

TCC epidemiology

A

50-60

male

113
Q

genetic features of papillary tumors

A

deletions in chromosome 9

114
Q

invasive, high grade tumors genetic feature

A

del in chromosome 17

115
Q

risk factors of TCC

A 
smoking
arylamines exposure
schistosoma
chronic usage of analgesics
cyclophosphamide
radiation
116
Q

Ta staging

A

non invasive papillary tumor

117
Q

Tis staging

A

carcinoma in situ

118
Q

T1 staging

A

lamina propria invaded

119
Q

T2 staging

A

muscularis propria invaded

120
Q

T 3a staging

A

microscopically beyond luminal wall

121
Q

T3b staging

A

gross protuberance beyond the luminal wall

122
Q

T4 staging

A

invasion of adjacent structures

123
Q

most common cause of urinary bladder obstruction in women

A

cystocele

124
Q

most common urinary bladder obstruction cause

A

prostate gland enlargement

125
Q

clinical triad or arthritis, conjunctivits and urethritis

A

Reiter syndrome

126
Q

urethritis classification

A

gonococcal

nongonococcal- E coli, Chlamydia, Mycoplasma

127
Q

originate from the posterior lip of the urethra
fleshy outgrowths of distal urethral mucosa
small, red, painful mass

A

uretheral caruncle

128
Q

cause of uretheral caruncle

A

distal uretheral prolapse

estrogen withdrawal

129
Q

benign neoplasms of urethra

A

squamous
urothelial papillomas
inverted urothelial papillomas
condyloma

130
Q

urothelial CA. within the proximal urethra show

A

urothelial

urothelial differentiation analogous to those within the bladder

131
Q

urothelial CA distal urethra

A

squamous CA

Pathology (5 decks)

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