MALE Genital I Flashcards
What is the differential diagnosis of hematuria? 3
cystitis
urolithiasis
neoplasms
What is the most common cause of cystitis?
Gram negative bacteria (E. coli)
What is the symptoms triad of cystitis?
frequency, dysuria, and lower abdominal pain
+/- hematuria
What is granulomatous cystitis secondary to? where is it mostly found?
- Renal tuberculosis
2. trigone- ureteral orifices
What is BCG- induced granulomas? Are the necrotizing?
- intravesicular administration of bacillus calmette-guerin (BCG) used for the Tx: of superficial bladder carcinoma
- No
What is malakoplakia due to? what do they look like grossly? What do we see microscopically?
- defects of phagocytic functions of macrophages
- 3-4 cm, soft, yellow, raised plaques
- PAS+ granules in large foamy macro., giant cells, lymphocytes, basophilic remnants in macrophages (michaelis-gutmann bodies)
What is the symptom of small stones passing into ureter?
Renal colic
Large stones may remain silent within the renal pelvis or give rise to what? 2
- hematuria
- superimposed infections
by obstruction and trauma
Is urinary bladder cancer more common in men or women?
men 3:1 50-80 years old
Review the epidemiology of bladder cancer
tobacco arylamines- anilines cyclophosphamide analgesic abuse bladder radiation schistosoma hematobium
What is the most common type of bladder cancer? 2nd?
Urothelial carcinoma
squamous cell carcinoma
What is an infectious cause of squamous cell carcinoma of the bladder?
schistosoma hematobium
What does urothelial carcinoma in situ look like grossly? what happens due to lack of cell cohesiveness? what happens if untreated?
- flat, reddened, thickened/granular
- Shedding into urine
- 50-75% progress to muscle invasive disease
What do we see microscopically in urothelial carcinoma in situ?
flat lesion, atypical cells with large, irregular hyper chromatic nuclei and mitoses
How many of bladder cancers are low grade papillary urothelial carcinoma? What does low stage mean? does it have a high recurrence rate? very progressive? What chromosome is involved?
- 2/3
- <10% invade
- yes
- No
- 9
What does low grade papillary urothelial carcinomas look like microscopically?
IS mitosis frequently seen?
- -fragile branching papillae
- covered by orderly urothelial cells with min. crowding or loss of polarity, round oval nuclei, mild variation, - Mitosis is infrequent
How many high grade papillary urothelial carcinomas invade? progressive?
- 80%
2. very progressive and high mortality
What does high grade urothelial carcinomas look like microscopically?
- -delicate branching or fused papillae
- covered by disorderly urothelial cells, loss of polarity, pleomorphic, nucleoli and mitoses.
What is the biggest prognostic factor in bladder cancer?
depth of invasion (stage)
others include- grade, multifocality, prior recurrence rate
In bladder cancer what stage corresponds to the following depths- muscular is propria? perivesical tissue? lamina propria? pelvic wall?
II
III
I
IV
What is the main clinical finding of urothelial carcinoma?
- painless hematuria
others include- frequency, urgency and dysuria
- obstruction of orifice, multiple recurrences, metastases
How do we treat bladder cancer if it is small, localized and low grade? What if it is multifocal?
- transurethral resection
2. resection then topical chemo
How do we treat high risk patients with high grade tumors etc.?
- Resection then topical immunotherapy- BCG bacillus calmette-guerin
Review the following indications for radical cystectomy
- invading muscularis propria
- CIS or high grade papillary cancer refractory to BCG
- extension into prostate
