[PATHO] URINARY BLADDER DISEASES Flashcards by Aseel Maher

defective anterior bladder & abdominal wall
exposed posterior vesical wall

ectopic vesica

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ectopic vesica can be associated w/

epispadias
split clitoris

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ectopic vesica complicated by (3)

1-UTI
2-squamous/glandular metaplasia
3-carcinoma

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fistulous tract from bladder to umbilicus

patent urachus

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valvles in posterior urethra can lead to

obstruction

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pouch-like complete envagination of all layers of wall of bladder

congenital diverticulum

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pouch-like complete mucosal envagination

acquired diverticulum

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acquired diverticulum caused by

persistent urethral obstruction by benign prostatic hyperplasia

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bladder diverticulum can lead to (3)

1-urinary stasis
2-recurrent infections
3-stone formation

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MC causative agent of cystitis

E.coli

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frequent micturition
dysuria
pyuria
suprapubic pain

acute cystitis

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predisposing factors of cystitis

1-bilharaziasis
2-trauma: stones, catheters
3-urine stasis
4-inflammation of nearby organs
5-congenital
6-diabetes

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frequent micturtion
dysuria
pyuria
suprapubic pain

acute cystitis

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gross picture of acute cystitis

bladder wall:
thickened
congested
edematous
red
Hg, necrosis, ulceration

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gross picture of chronic non-specific cystitis

thickened congested wall
fibrosis
granular mucosa
reduced lumen

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female
persistent
painful
non specific inflammation
extends to muscle layer
ends in transmural fibrosis

interstitial chronic non specific cystitis

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polyploid projections of bladder
due to submucosal edema

polyploid chronic non specific cystitis

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rare cystitis
immunodeficient patient
multiple nodular yellow plaques in mucosa of trigone

malakoplakia

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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

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A) Michaelis–Gutman bodies?
B) seen in?

A) calcified bodies; end stage of bacteria degradation
B) chronic non specific cystitis

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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