Pathology 2 Flashcards
epithlium in bladder?
lots of folds
transitional epithelium (stratified, looks like squamous)
has ability to thin out when bladder distends
has umbrella cells on surface and 5-6 layers of epithelium beneath
what structures are lined by transitional epithelium?
ureters
bladder
most of urethra
what is cystitis?
inflammation in the bladder? 3 main groups of causes - parasites and mycotic infection - aseptic - reactive to cathters
main parasitic cause of cystitis?
schistosomiasis haematobium
often picked up in water
not actually toxic, its just body’s reaction to it that causes problem
parasite leaves eggs behind that calcify and body continues to react to it
where is schistosomiasis commonly found?
lake malawi
what can schistosomiasis lead to?
metastatic change from transitional to keratinised squamous epithelium
can eventually lead to squamous cell carcinoma
squamous cell carcinoma in the bladder indicates what?
something causing metaplastic change (e.g persistent inflammation)
iatrogenic cause of persistent inflammation in the bladder and what does this lead to?
in-dwelling catheter
scarring, metaplasia and eventually squamous cell carcinoma
what groups are at higher risk of SCC in the bladder?
paraplaegics
have no sensation in the bladder so don’t know they have inflammation
what is aseptic cystitis?
used to be called interstitial cystitis
no causative organism, may be a kind of hypersensitivity reaction
persistent symptoms of UTI (dysuria etc)
persistently negative cultures and urinalysis and no reaction to antibiotics
describe pathology of aseptic cystitis on biopsy
some inflammation
congestion
mast cells
- often biopsied as don’t know what’s causing inflammation
what is cystitis cystica?
descriptive term of florid inflammation causing infolding of bladder mucosa into cysts
- not really cysts, folding just looks like cysts
2 other causes of bladder inflammation?
diverticulae in bladder - stagnant urine, infection, stones and cancer
obstruction - prostatism (bladder muscle works hard and becomes trabeculated (thickened and ridged) eventually causing back pressure)
how can obstruction cause a problem?
any obstruction, stone or tumour can cause back pressure (last point in the tract is kidney)
collecting system then becomes dilated and causes hydronephrosis
describe hydromephrosis?
kidney is normal size, just full of urine instead of kidney structures
how does site of blockage affect damage to kidneys?
if lower down (urethra etc) back pressure will affect both kidneys
if upper in the tract (e.g in one ureter) only 1 kidney affected
common bladder cancer?
urothelial neoplasia (type of transitional cell carcinoma) - occurs in middle aged and elderly (both genders)
main risk factors for urothelial neoplasia?
smoking (huge association,
working in the dye industry
describe transitional cell carcinoma
often papillary - finger like projection
can also see CIS (carcinoma in situ?) - flat
difference in size of nuclei
other types of bladder cancer (less common) and what causes it?
adenocarcinoma
often occurs on a background of metaplasia
- therefore difficult to distinguish from colon cancer which has invaded through
urethrocarcinoma
what are the rectum and bladder derived from?
alantois = bladder rectum = cloaca
what is the urachus?
remnant of the alntois
connects between dome of bladder to the umbilicus
usually involutes
can remain patent in some people and adenocarcinoma can develop inside
when can squamous cell carcinoma occur in the bladder?
background inflammatory change (metaplasia etc)
function of prostate?
secretes prostatic fluid and fluid from seminal vesicles
some contractile function during ejaculation
don’t really need it so can be removed if cancerous
normal prostate histology?
bilayered acinar structures
looks frilly
normal to have a little bit of hyperplasia
how does prostate change in life?
continues to get bigger with ageing under hormonal influence
affects central and transitional zones which can affect flow of urine
where in the prostate does hyperplasia usually affect, what does this mean for management?
centrally (central and transitional)
means transurethral resection is needed (cant just shave a bit off the side)
how common is prostate cancer?
at 50 - 30% have it
at 70 - 70%
at 90 - 90%
however most are low grade and slow growing so older people commonly die of something else first and patients often are just followed up
risk factors for prostate cancer?
not a clear cause as it so common
cadmium batteries
where does prostate cancer often occur on the gland?
periphery
therefore biopsy is done transrectal
which is more associated with hormones, BPH or prostate cancer?
BPH
how is prostate cancer diagnosed?
PSA (not specific, only shows enlargement) transrectal biopsy (5-6 in each lobe)
why is PSA unreliable?
high grade cancer cells are less like normal prostate epithelial cells
therefore high grade cancers wont produce PSA so ca have normal PSA with high grade cancer
what benign things can cause in increase in PSA?
PR exam BPH prostitis spironolactone riding a bike
how can PSA be used post treatment?
to follow up and check for recurrence
how is prostate cancer graded?
gleason grading
- combination of 2 numbers, each out of 5
- lowest grade = 6 (3+3)
- highest grade = 10 (5+5)
