[PATHO] URINARY BLADDER DISEASES Flashcards
defective anterior bladder & abdominal wall
exposed posterior vesical wall
ectopic vesica
ectopic vesica can be associated w/
epispadias
split clitoris
ectopic vesica complicated by (3)
1-UTI
2-squamous/glandular metaplasia
3-carcinoma
fistulous tract from bladder to umbilicus
patent urachus
valvles in posterior urethra can lead to
obstruction
pouch-like complete envagination of all layers of wall of bladder
congenital diverticulum
pouch-like complete mucosal envagination
acquired diverticulum
acquired diverticulum caused by
persistent urethral obstruction by benign prostatic hyperplasia
bladder diverticulum can lead to (3)
1-urinary stasis
2-recurrent infections
3-stone formation
MC causative agent of cystitis
E.coli
frequent micturition
dysuria
pyuria
suprapubic pain
acute cystitis
predisposing factors of cystitis
1-bilharaziasis
2-trauma: stones, catheters
3-urine stasis
4-inflammation of nearby organs
5-congenital
6-diabetes
frequent micturtion
dysuria
pyuria
suprapubic pain
acute cystitis
gross picture of acute cystitis
bladder wall:
thickened
congested
edematous
red
Hg, necrosis, ulceration
gross picture of chronic non-specific cystitis
thickened congested wall
fibrosis
granular mucosa
reduced lumen
female
persistent
painful
non specific inflammation
extends to muscle layer
ends in transmural fibrosis
interstitial chronic non specific cystitis
polyploid projections of bladder
due to submucosal edema
polyploid chronic non specific cystitis
rare cystitis
immunodeficient patient
multiple nodular yellow plaques in mucosa of trigone
malakoplakia
microscopic picture of chronic non specific cystitis
subepithelial tissue contains:
1-chronic inflam cells
2-FB giant cells containing Michaelis-Gutman bodies
3-Brunn’s nests
4-cystitis cystica
5-cystitis glandularis
6-Leukoplakia
A) Michaelis–Gutman bodies?
B) seen in?
A) calcified bodies; end stage of bacteria degradation
B) chronic non specific cystitis
epithelial microscopic changes seen in chronic non specific cystitis
Brunn’s nests
cystitis cystica
cystitis glandularis
Leukoplakia occurs due to
squamous metaplasia with keratinization
types of chronic specific cystitis
Bilharzial
Tuberculous
TB cystitis occurs 2ry to
Renal TB
gross, microscopic picture of TB cystitis
tubercles in subepithelial tissue
overlying epithelium becomes ulcerated
malignant bladder occur more in
males
40 years+
Risk factors of malignant bladder tumors (6)
1-Schistosomiasis
2-Smoking
3-Stones
4-Cystitis
5-Congenital
6-Carcinogens (Aniline dyes)
MC site of malignant epithelial neoplasms
trigone
how are ureters affected in case of malignant epithelial neoplasms
partial/complete blockage of one or both ureters
genetic predisposition in case of urothelial superficial carcinoma
mutation & activation of RAS oncogene & FGFR3 gene
genetic predisposition in case of urothelial muscle invasive tumors
mutation & inactivation of TP53 & RB tumor suppressor genes
precursor lesions of invasive urothelial carcinoma
1-non invasive papillary urothelial neoplasms
2-CIS
non invasive papillary urothelial neoplasm cc
project into lumen
delicate papillary appearance
grades of non invasive urothelial papillary neoplasm
1-papilloma
2-papillary urothelial neoplasm of low malignant potential
3-low grade papillary urothelial carcinoma
4-high grade papillary urothelial carcinoma
papilloma cc
papillae covered by normal urothelium
papillary urothelial neoplasm of low malignant potential
-papillae covered by thickened urothelium> 7 layers
-no/minimal atypia
low grade papillary urothelial carcinoma
-papillae covered by atypical urothelium
-low grade anaplasia
high grade papillary urothelial carcinoma
-papillae covered by highly atypical urothelium
-frequent mitosis
high grade malignant cells
multifocal
taking full thickness of urothelium
lamina propria: NO INVASION
progress to muscle-invasive cancer w/o treatment
CIS within flat urothelium
papillary/ulcerative lesions
extends into underlying muscle layer
lamina propria: INVADED
associated w/ high grade papillary urothelial carcinoma
OR
due to CIS progression into invasive cancer
invasive urothelial carcinoma
microscopic picture of invasive urothelial carcinoma
-high grade infiltrating papillary epi cells
-diffuse sheets of malignant transitional epi cells
-squamous/glandular differentiation
gross picture of invasive urothelial carcinoma
papillary or solid ulcerative lesions
prognosis of invasive urothelial carcinoma depends on
extent of invasion
TTT of non-invasive or superficially invasive tumors
cystoscopic resection
BCG
Cystectomy is done in case of
1-Muscle invasion
2-CIS not responding to BCG
3-high grade papillary urothelial carcinoma not responding to BCG
4-CIS extending to prostatic urethra
associated w/ bilharziasis
large macroscopic bulky mass
well differentiated
keratinizing
squamous metapllasia
Squamous cell carcinoma
cystadenocarcinoma arises from
1-urachal remnants in dome of bladder
2-cystitis glandularis
total hematuria
blood from kidneys
Terminal hematuria
blood from bladder
Initial hematuria
blood from urethra
causes of hematuria (8)
1-HTN
2-Bleeding tendencies
3-Leukemia
4-Congenital CPKD
5-Inflammations
6- Stones
7-Tumors
8- Prostatic nodular hyperplasia
