Male Path 1 Flashcards
What are the three layers of the bladder?
- urothelium
- 5-7 layers
- umbrella (superficial), intermediate, and basal layer
- urine blood barrier
- ability to dilate and contract - lamina propria
- loose connective tissue, delicate bundles of smooth muscle fibers- muscularis mucosae - muscularis propria
- deep muscle, detrusor muscle; muscle wall arranged in several layers
What is the most common cause of hydronephrosis in children?
ureteropelvic junction obstruction
Ureteritis/ Cystitis cystica
up to 60% of bladder
- von Brunn’s nests with degenerated central cells to form small cystic cavities
- translucent submucosal pearly-yellow cysts, usually up to 5mm
NOT INFLAMMATION
What are intrinsic vs extrinsic obstructions of the urinary tract?
Intrinsic
- calculi
- strictures
- tumors
- blood clots
- neurogenic
Extrinsic
- pregnancy
- periureteral inflammation
- endometriosis
- retroperitoneal fibrosis
- tumors
What is exstrophy of the bladder?
developmental failure in the anterior wall of the abdomen and in the bladder
Acute and Chronic cystitis
women (short urethras)
- predisposing factor: bladder calculi, urinary obstruction, diabetes mellitus, instrumentation, immune deficiency
- Coli forms: e. coli, proteus klebsiella, enterobacter, staph saprophyticus
- frequence, pain, dysuria, fever
-peticheal hemorrhages and chronic inflammatory cells
Interstitial Cystitis-Chronic pelvic pain syndrome Epidemiology Patholgoy Symptoms Cystoscopic findings Histology Treatment
Non-bacterial form of cystitis (negative cultures and cytology)
90% female
30-50 years
- Associated with allergies and autoimmune
- intermittent, often severe, suprapubic pain, urinary frequency, urgency, hematuria, and dysuria
cystoscopic findings: fissures and punctate hemorrhages
Pathology:
- some patients have chronic mucosal ulcers (Hunner’s ulcer),
- MAST CELLS, could be seen-most important to distinguish from carcinoma in situ
Treatment: empiric. diminished bladder capacity
Malakoplakia Symptoms Cystoscopy Histology Epidemiology: Other sides:
Symptoms:
Recurrent fever, bladder irritability and pain, hematuria, pyuria, weight loss
Cystoscopy: multiple raided soft yellow to brown plaques and nodules
Histology:
-dense infiltrate of large foamy macrophages with finely granular eosinophilic cytopalsm (von Hansemann histiocytes)
-blue targetoid calcospherules (Michaelis-Gutmann bodies)
Epidemiology:
-more common in females, 5th decade
Related to chronic bacterial infection (e coli)
Other body sites: colon, lung, kidney, other GU side
Leukoplakia
Cause
Risk for
HIstology
long term irritation or chronic infection- stones, non functioning bladders, schistosomiasis
-if extensive may interfere with contraction and dilation
Risk factor for development of carcinoma *******
Histology-keratinizing squamous epithelium
Bladder Cancer
Epidemiology
Clinical Presentation
Etiology
Epidemiology
Male: Female 3:1
Age 50-80-average age diagnosis 65
Bladder is the most common site for urothelial carcinoma
Clinical Presentation
- Painless hematuria 80%
- irritative symptoms (dysuria, frequency urgency-mostly seen in high grade and invasive carcinomas)
- flank pain, bone pain, pelvic mass
Etiology
- Cigarette smoking**
- Arylamines
- Chronic cystitis
- Schistosomiasis—egypt
- UTI
- Indwelling catheters
- Urolithiasis - Cyclophosphamide-acrolein metabolite
- Long term analgesic usage (phenacetin)
- pelvic irradiation
What are the steps of the papillary pathway of bladder cancer, which is 80% of bladder cancer?
- Hyperplasia (papillary urothelial hyperplasia)
- Genetically instable?!? FGFR3
- Low grade carcinoma
- RAS?
- High grade carcinoma
- Invasive Carcinoma
What are the steps of the non papillary pathway of bladder cancer, which is 20% of bladder cancer?
- 9p-, 9q-, p16
- Dysplasia (flat noninvasive carcinoma)
3a. Genetically instable p53 (~60%)–High grade carcinoma—Invasive Carcinoma
3b. (
If untreated 50%-70% of carcinoma in situ progress to what?
muscle invasive cancer
Urothelial papilloma
1% of papillary urothelial tumors
Papillary urothelial neoplasm of low malignant potential (PUNLMP)
papillary urothelial lesion with orderly arranged cells within papillae with minimal architectural abnormalities and minimal nuclear atypia
M> F (3-5:1)
MALE
- cytology negative
- increased urothelial thickness, preserved polarity
- mitoses-very rare, basal
local recurrence 30%, progression 5%
Molecular findings
- diploid with low proliferative rate
- FGFR3 mutation-85%
Low grade urothelial carcinoma
- slender papillary branching fronds with minimal fusion
- easily recognized variation in architectural and cytological features-nuclear enlargement
- mytosis may be present at any level
- cytology-mostly negative
local recurrence 50-70%
progression 10%
Molecular findings
- diploid with low proliferative rate
- FGFR3 mutation-88%
- altered expression of CK20, CD44, p53 and p63 may be seen
High grade urothelial carcinoma
Papillary fronds with obvious disordered arrangement (fusion) and cytologic atypia
- pleomorphism, altered polarity, mitosis
- low power diagnosis
- cytology positive
- local recurrence 36-60%
- progression 40-60%
- disease specific mortality 15%
Molecular findings:
- aneuploid with high proliferative rate
- altered expression of CK 20, CD44, p53 and p63
As tumor grade and pathology stage progress, what occurs with FGFR3 and P53?
P53 increases
FGFR3 decreases
