Pathology - Handorf 2

Question 1

Ureters

Answer 1

-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

Question 2

Obstructive Lesions of Ureter: Intrinsic

Answer 2

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

Question 3

Obstructive Lesions of Ureter: Extrinsic

Answer 3

• pregnancy
• periureteral inflammation
• sclerosing retroperitoneal fibrosis
• endometriosis
• neoplasms

Question 4

Can pregnancy cause partial obstruction of the ureter?

Answer 4

yes

Question 5

Hydronephrosis

Answer 5

• 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

Question 6

Periureteral Inflammation

Answer 6

• salpingitis
• diverticulitis
• peritonitis
• sclerosing retroperitoneal fibrosis

Question 7

Salpingitis

Answer 7

-inflammation of fallopian tube

Question 8

Diverticulitis

Answer 8

-inflammation of intestinal diverticulum and surrounding ttissues

Question 9

Peritonitis

Answer 9

inflammation of peritoneum

Question 10

sclerosing retroperitoneal fibrosis

Answer 10

• 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)

Question 11

Cells of Urinary Bladder

Answer 11

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

Question 12

Endometriosis

Answer 12

• 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

Question 13

Ureteritis Cystica

Answer 13

• 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

Question 14

Congenital Anomalies of Ureters: Double

Answer 14

-usually accompanied by partial or complete duplication of renal pelvis

Question 15

Congenital Anomalies of Ureters: Ureteropelvic Junction Obstruction

Answer 15

• 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

Question 16

Congenital Anomalies of Ureters: Diverticula

Answer 16

• 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

Question 17

Congenital Anomalies of Ureters

Answer 17

2-3% of all autopsies

Question 18

Urinary Bladder: Congenital & Acquired Anomalies

Answer 18

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

Question 19

Urinary Bladder Anomalies Causes

Answer 19

• 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

Question 20

Diverticuli

Answer 20

• pouch-like evaginations of bladder wall

- sites of urinary stasis, with potential for infection

Question 21

Congential Diverticuli

Answer 21

-caused by focal muscular defect

Question 22

Acquired Diverticuli

Answer 22

• more common

- arise following persistent urethral obstruction

Question 23

Exstrophy

Answer 23

• 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)

Question 24

Urachus

Answer 24

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

Question 25

Cystocele

Answer 25

- 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

Question 26

Inflammations of Urinary Bladder

Answer 26

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

Question 27

Malakoplaki

Answer 27

- 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

Question 28

Bladder Tumors

Answer 28

- 95% in epithelial origin, rest are mesenchymal | - epithelial composed of urothelial (transitional) type

Question 29

Most common to cause Cystitis?

Answer 29

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

Question 30

Cystitis Glandularis

Answer 30

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

Question 31

Interstitial Cystitis

Answer 31

``` 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 ```

Question 32

Majority of Bladder Cancers

Answer 32

- 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

Question 33

Squamous Carcinoma of the Bladder

Answer 33

-nonsmoker, Egyptian, Nile River Delta

Question 34

Adenocarcinoma of Bladder

Answer 34

- 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

Question 35

Non-gonococcal Urethritis

Answer 35

-E. coli, chlamydia, mycoplasm

Question 36

Urethral Caruncle

Answer 36

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

Question 37

Papillomas

Answer 37

tumor - occur usually on the external meatus - viral origin, similar to those affecting the vulva

Question 38

Carcinoma of the urethra

Answer 38

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