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Reproductive > PATH: Lower Urinary Tract > Flashcards

PATH: Lower Urinary Tract Flashcards

1
Q

List some intrinsic causes of ureter obstruction.

A
  • Stones
  • Strictures
  • Neoplasms
  • Blood clots
  • Neurogenic causes
  • Vesicoureteral reflux
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2
Q

List some extrinsic causes of ureter obstruciton.

A
  • Pregnancy
  • Periureteral inflammation
  • Sclerosing retroperitoneal fibrosis
  • Endometriosis
  • Neoplasms
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3
Q

When you see “urinary stasis” what should you automatically think of?

A

INFECTION (static urine provides a rich culture medium)

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4
Q

How does ureter obstruction lead to hydronephrosis?

A

If long-standing interruption of normal outflow of urine from renal pelvis, the pelvis distends and increases pressure on the parenchyma of the kidney

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5
Q

List the causes of periureteral inflammation.

A

1) Salpingitis
2) Diverticulitis
3) Peritonitis

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6
Q

What is a fibrous proliferative inflammatory process that can encase retroperitoneal structures (including the ureter)?

A

sclerosing retroperitoneal fibrosis

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7
Q

Who gets sclerosing retroperitoneal fibrosis?

A

rare; middle to late age

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8
Q

70% of sclerosing retroperitoneal fibrosis is caused by what?

A

trick question (no obvious cause in 70%)

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9
Q

What are the identifiable causes of sclerosing retroperitoneal fibrosis?

A

Drugs
Crohn’s disease
malignant disease

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10
Q

What is the pathogenesis underlying ureteritis follicularis?

A

accumulation of lymphocytes in the subepithelial region of the ureter in chronic ureteritis may produce fine granularity of the mucosa

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11
Q

What is it called when the ureters have little 1-5 mm cysts filled with clear yellow fluid?

A

ureteritis cystica

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12
Q

What causes ureteritis?

A

UTIs

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13
Q

Who gets ureteropelvic junction obstruction?

A

infants or children (more common in boys, more common on the left)

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14
Q

What is the consequence of ureteropelvic junction obstruction?

A

hydronephrosis

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15
Q

What is the word for saccular outpouchings of the ureteral wall?

A

diverticula

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16
Q

How might you acquire a diverticula?

A

increased pressure secondary to obstruciton of urine outflow

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17
Q

What complication would you expect with a diverticula?

A

urinary stasis–> infection

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18
Q

What are some things that might obstruct the bladder?

A

1) enlarged prostate
2) cystocele of bladder
3) strictures of urethra
4) bladder tumors
5) post inflammatory fibrosis/contraction of bladder after cystitis
6) secondary invasion of bladder neck by growths
7) calculi
8) neurogenic bladder (injury to innervation)

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19
Q

What is characteristic finding of a bladder that has been exposed to chronic obstruction?

A

trabeculation of the bladder wall

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20
Q

What is the name for a developmental defect of closure of the anterior wall of the abdomen and the bladder so that the bladder communicates with the exterior of the body through a large defect or as an open sac?

A

exstrophy of the bladder

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21
Q

What is a possible complication of bladder exstrophy?

A

increased incidence of adenocarcinoma

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22
Q

What is the name for a vestigial structure between the apex of the bladder and the umbilicus?

A

urachus

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23
Q

What was the original role of the urachus?

A

connected bladder with allantois

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24
Q

What might be a complication of a uracheal cyst?

A

provide spot for adenocarcinomas to arise

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25
Q

What might be a complication of a sequestered umbilical epithelial rest or bladder diverticulum?

A

infection

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26
Q

What is a cystocele?

A

protrusion of the bladder into the vagina (creating a pouch)

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27
Q

What leads to a cystocele?

A

uterine prolapse from loss of pelvic support

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28
Q

What feature of the intramural segment of the ureteral orifice permits the enclosing bladder musculature to act like a sphincter?

A

the oblique angled course (entry angle) of the ureter into the bladder)

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29
Q

What does a defect in the intravesicle portion of the ureter lead to?

A

vesicoureteral reflux

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30
Q

What are the common causes of acute cystitis?

A

E coli (MAJOR)
Proteus
Klebsiella
Enterobacter

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31
Q

What are some non-infectious causes of acute cystitis?

A

cytotoxic anti-tumor drugs
radiaton
trauma

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32
Q

What are the symptoms of cystitis?

A 
urinary frequency
lower abdominal pain
dysuria
\+/- fever
chills
malaise
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33
Q

What is in the inflammatory exudate of acute cystitis?

A

neutrophils

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34
Q

What is in the inflammatory exudate of chronic cystitis?

A

lymphocytes, plasma cells, and macrophages

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35
Q

What is follicular cystitis?

A

in chronic cystitis when lymphocytes form lymphoid follicles within the bladder mucosa and submucosa

36
Q

In what condition can you develop a Hunner Ulcer?

A

Interstitial Cystitis

37
Q

Who gets interstitial cystitis?

A

middle aged women

38
Q

What are the symptoms of interstitial cystitis?

A

INERMITTENT, often severe suprapubic pain, urinary freuqency, urgency, hematuria and dysuria (w/o evidence of infection)

39
Q

What is the cause of malakoplakia?

A

defective host response to a bacteria (usually GN bacilli) infection

40
Q

What is the characteristic microscopic finding of malakoplakia?

A

Michaelis-Gutmann bodies (laminated mineralized concretions within and between macrophages)

41
Q

What are contianed with macrophages/giant cells of malakoplakia?

A

PAS+ granules filled with bacterial debris

42
Q

What are the “nests” that develop due to chronic cystitis that grow down into the LP?

A

Brunn nests

43
Q

What happens to Brunn nests in the LP?

A

may undergo glandular metaplasia (cystitis glandularis)

OR retract to produce cystic spaces lined by flattened urothelium (cystitis cystica)

44
Q

What complication of chronic cystitis may predispose to adenocarcinoma of the bladder?

A

cystitis glandularis

45
Q

What is more common, epithelial or mesenchymal bladder cancer?

A

EPITHELIAL (95%) and of these 90% are transitional cell (urotehlial)

46
Q

What are the two morphological patterns of urothelial tumors

A

papillary and flat

47
Q

What is the classic patient who gets bladder cancer?

A

50-80 yo male SMOKER

48
Q

True or false: many bladder tumors are multifocal at presentaiton.

A

TRUE

49
Q

What mutation is typically found in non-invasive low-grade papillary carcinoma?

A

gain-of-function mutaitons in FGFR3

50
Q

What mutation is typically found in high-grade and muscle invasive tumors (papillary or flat)?

A

Loss-of-function in TP53 and RB tumor supressor genes

51
Q

What mutation is commonly seen in low-grade non-invasive papillary (papillomas) or flat (CIS) carcinomas?

A

activating mutaiton in HRAS oncogene

52
Q

Do papillomas typically have both HRAS oncogene activation and FGFR3 activations?

A

NO–generally mutually exclusive

53
Q

What is probably the earliest mutation seen in low-grade non-invasive papillary (papillomas) or flat (CIS) carcinomas?

A

losses of genetic material on chromosome 9

54
Q

What are the two major genes that are lost with chromosome 9 deletions?

A

CDKN2A (9p)

PTCH (9q)

55
Q

Loss of CDKN2A has what effect?

A

loss of p16/INK4a and ARF (protein that augments p53 function)

56
Q

Loss of PTCH has what effect?

A

lack of negative regulation of the Hedgehog signaling pathway (no TSC1 to negatively regulate mTOR signaling)

57
Q

What is the “less aggressive” pathway for bladder carcinogenesis?

A

FGFR3 and RAS mutations + chromosome 9 deletions–> lead to low-grade superficial papillary tumors–> minority may lose TP53 or RB funciton–> invade

58
Q

What is the “more aggressive” pathway for bladder carcinogenesis?

A

TP53 mutations inititate noninvasive high-grade flat or papillary lesions–> loss of chromosome 9 + other mutations –> progression to invasion

59
Q

What is the classic presentation of urothelial carcinoma of the bladder?

A

painless hematuria (may have increased frequency, urgency and dysuria too)

60
Q

True or false: most bladder cancers are low grade lesions.

A

FALSE

61
Q

Where do most bladder cancers arise?

A

lateral or posterior walls of the bladder base

62
Q

Do all bladder carcinomas spread hematogenously?

A

no, only highly anaplastic tumors

63
Q

What does a papilloma look like?

A

finger-like papillae with a central core of loose fibrovascular tissue covered by transitional epithelial cells

64
Q

What patients are candidates for a radical cystectomy?

A

1) Tumor invading muscularis propria
2) CIS or high-grade papillary cancer refractory to BCG
3) CIS extending into the prostatic urethra and prostatic ducts (where BCG cannot reach it)

65
Q

How is the prognosis of bladder cancer unique?

A

tumor grade determines more of the prognosis

66
Q

True or false: the higher the grade of urothelial tumor, the higher the chance of recurrence.

A

true!

67
Q

Squamous cell carcinoma of the bladder is associated with what?

A 
Schistosomiasis (Egyptian males)
Chronic irritation (caculi)
68
Q

Why does squamous cell carcinoma have a worse prognosis than urothelial?

A

higher stage at presentation

69
Q

If you see adenocarcinoma of the bladder, what should you think of?

A

urachal remnant or exstrophy (VERY RARE)

70
Q

What are the 2 types of sarcoma that may be in the bladder?

A

Rhabdomyosarcoma

Leiomyosarcoma

71
Q

What are the divisions of urethritis?

A

gonoccocal

non-gonococcal (E. coli, chlamydia, etc.)

72
Q

What disease (arthritis and conjunctivitis) has urethritis associated with it?

A

Reiter syndrome

73
Q

What is the name of the inflammatory lesion presenting as a small, red, painful friable mass about the external urethral meatus in the female patient?

A

urethral caruncle

74
Q

What is the most common type of urethral carcinoma

A

squamous cell carcinoma

75
Q

Who gets carcinoma of the urethra?

A

rare; older women

76
Q

What is epidspadias?

A

abnormal opening of urethera on dorsal side of the penis

77
Q

What is hypospadias?

A

abnormal opening of urethera on ventral side of the penis

78
Q

Which is more common, hypospadias or epidspadias?

A

hypospadias

79
Q

What is the name of the inability to easily retract the foreskin of the penis?

A

phimosis

80
Q

What is the complicaiton of phimosis?

A

accumulation of secretions under the prepuce which leads to inflammation (blaanoposthitis= posthitis)

81
Q

What is the cause of phimosis?

A

poor hygeine

82
Q

What would you call squamous cell carcinoma on the shaft of the penis?

A

Bowen disease

83
Q

What ould you call squamous cell carcinoma on the glans of the penis?

A

erythroplasia of Queyrat

84
Q

What are 80% of squamous cell carcinomas of the penis related to?

A

HPV (usually type 16)

85
Q

True or false: almost all squamous cell carcinomas occur in men who are circumcised.

A

FALSE: almost all in uncircumcised males

Reproductive (21 decks)

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