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Reproductive > Pathology - Handorf 2 > Flashcards

Pathology - Handorf 2 Flashcards

1
Q

Ureters

A

-muscular tubes
25-30cm long, 5-10mm diameter
-leading from renal pelvis to urinary bladder
1. mucosa
2. muscularis
3. adventitia
-not passive, peristaltic contraction of muscle layer propels the urine

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2
Q

Obstructive Lesions of Ureter: Intrinsic

A
  • calculi (stones)
  • strictures
  • neoplasms
  • blood clots
  • neurogenic causes
  • vesicoureteral reflux
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3
Q

Obstructive Lesions of Ureter: Extrinsic

A
  • pregnancy
  • periureteral inflammation
  • sclerosing retroperitoneal fibrosis
  • endometriosis
  • neoplasms
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4
Q

Can pregnancy cause partial obstruction of the ureter?

A

yes

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5
Q

Hydronephrosis

A
  • obstruction of ureter, results in obstruction is interruption of normal outflow of urine from renal pelvis which creates distention of pelvis and increased pressure on parenchyma of kidney
  • results in hydronephrosis and possibly pyelonephritis
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6
Q

Periureteral Inflammation

A
  • salpingitis
  • diverticulitis
  • peritonitis
  • sclerosing retroperitoneal fibrosis
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7
Q

Salpingitis

A

-inflammation of fallopian tube

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8
Q

Diverticulitis

A

-inflammation of intestinal diverticulum and surrounding ttissues

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9
Q

Peritonitis

A

inflammation of peritoneum

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10
Q

sclerosing retroperitoneal fibrosis

A
  • fibrous proliferative inflammatory process encasing retroperitoneal structures including ureter & causing compressing of ureter
  • rare,middle-late age
  • 70% no obvious cause (drugs, Crohn’s disease, malignant disease)
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11
Q

Cells of Urinary Bladder

A
  • basal cell
  • intermediate cell
  • umbrella cell
  • basement membrane
  • subepithelial connective tissue (lamina propria)
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12
Q

Endometriosis

A
  • presence of endometrial tissue (ectopic) outside of uterus
  • found on surface of organs adjacent to uterus, fallopian tubes, ovaries; sometimes adj to ureters, urinary bladder or intestines
  • tissue is functionally active, responds to stimulation by hormones
  • proliferation followed by bleeding & scarring can cause ureter compression
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13
Q

Ureteritis Cystica

A
  • may dev. as component of urinary tract infections
  • sig. morphologic changes arise in longstanding ureteritis
  • assumulation of lymphocytes in subepithelial region of ureter in chronic ureteritis may produce fine granularity of mucosa (ureteritis follicularis)
  • cystica in which mucosa of ureter shows fine cysts (1-5mm) filled with clear yellow fluid
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14
Q

Congenital Anomalies of Ureters: Double

A

-usually accompanied by partial or complete duplication of renal pelvis

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15
Q

Congenital Anomalies of Ureters: Ureteropelvic Junction Obstruction

A
  • usually present in infants/children, boys>girls, more on left
  • abnormal organization of excess stromal depositison of collagen b/w smooth muscle bundles
  • causes hydronephrosis
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16
Q

Congenital Anomalies of Ureters: Diverticula

A
  • saccular outpouchings of ureteral wall (uncommon)
  • appear as congenital/acquired (due to increased pressure secondary to obstruction of urine flow) important as pockets of stasis and secondary infection
17
Q

Congenital Anomalies of Ureters

A

2-3% of all autopsies

18
Q

Urinary Bladder: Congenital & Acquired Anomalies

A
  • obstruction to the bladder neck
  • diverticula
  • exstrophy
  • urachus
  • cystocele
  • vesicoureteral reflux
19
Q

Urinary Bladder Anomalies Causes

A
  • enlarged prostate
  • cystocele of bladder
  • post inflammatory fibrosis & contraction of bladder after varying types of cystitis
  • bladder tumors
  • sec. invasion of bladder neck by growths arising in perivesicule structures (cervix, vagina, prostate, rectum)
  • mechanical obs. caused by calculi
  • injury to innervation of bladder causing neurogenic or cord bladder
20
Q

Diverticuli

A
  • pouch-like evaginations of bladder wall

- sites of urinary stasis, with potential for infection

21
Q

Congential Diverticuli

A

-caused by focal muscular defect

22
Q

Acquired Diverticuli

A
  • more common

- arise following persistent urethral obstruction

23
Q

Exstrophy

A
  • developmental defect of closure of anterior wall of the abdomen and the bladder so the bladder communicates with the exterior of the body through a large defect or open sac
  • often associated with other abnormalities of GU tract
  • increased incidence of malignancy (adenocarcinoma)
24
Q

Urachus

A

-5-6cm vestigial structure located b/w apex of bladder and umbilicus

25
Q

Cystocele

A
  • protrusion of bladder into the vagina, creating a pouch
  • caused by relaxation of pelvic support in females, leading to uterine prolapse (pulls bladder floor downward)
  • frequently turn into bladder adenocarcinomas
26
Q

Inflammations of Urinary Bladder

A

-acute/chronic cystitis
-special forms of cystitis
interstital cystitis (Hunner Ulcer)
malakoplaki
cystitis glandularis
cystitis cystica

27
Q

Malakoplaki

A
  • soft, yellow 3-4cm mucosal plaques composed of closely packed, large, foamy macrophages with occasional giant cells and interspersed lymphocytes
  • macrophages contain PAS+ granules filled with bacterial debris
  • Michaelis-Gutmann bodes: laminated mineralized concretions within and b/w macrophages
  • most likely represents a defective host response to bacterial infections, usually from gram - bacilli
28
Q

Bladder Tumors

A
  • 95% in epithelial origin, rest are mesenchymal

- epithelial composed of urothelial (transitional) type

29
Q

Most common to cause Cystitis?

A

-E coli.&raquo_space;> then Proteus, Klebsiella, Enterobacter, TB, candida, cryptococcus, schistosoma, virus, chlamydia, mycoplasm - cytotoxic drugs, radiation, trauma

30
Q

Cystitis Glandularis

A
  • cysts are 0.1-1cm, filled with clear fluid, lined by cuboidal or urothelial cells
  • MAY predispose to adenocarcinoma of bladder
31
Q

Interstitial Cystitis

A 
Hunner Ulcer 
-Persistent, Chronic Cystitis
-most frequent in middle aged women 
feamale>male 10:1
-intermittent, severe suprapubic pain, urinary frequency, urgency, hematuria, dysuria without bacterial infection
32
Q

Majority of Bladder Cancers

A
  • high-grade
  • most arise from the lateral or posterior walls at the bladder base, partial or complete ureteral obstruction commonly occures
  • most >50, male to female 3:1
33
Q

Squamous Carcinoma of the Bladder

A

-nonsmoker, Egyptian, Nile River Delta

34
Q

Adenocarcinoma of Bladder

A
  • rare (2% of primary bladder cancer)
  • develops in setting of cystitis glandularis, exstrophy or in urachal remnant
  • unlike TCC, solitary lesion
  • generally deeply invasive
  • like colon cancer (therapy?)
  • poor prognosis
35
Q

Non-gonococcal Urethritis

A

-E. coli, chlamydia, mycoplasm

36
Q

Urethral Caruncle

A

tumor
-inflammatory lesion presenting as small, red, painful, friable mass about the external urethral meatus in female patient
-at any age, more common in later life
Histologically: highly vascular, young, fibroblastic connective tissue heavily infiltrated with leukocytes

37
Q

Papillomas

A

tumor

  • occur usually on the external meatus
  • viral origin, similar to those affecting the vulva
38
Q

Carcinoma of the urethra

A

tumor

  • rare
  • advanced age, women
  • arises in external meatus or immediately surrounding structures, most of these are squamous cell carcinomas
  • more aggressive than bladder cancers

Reproductive (14 decks)

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