Pathology II Flashcards
Where is urothelium present?
Not just bladder = ureters and collecting system of kidney, significant portion of the urethra
What does the distribution of urothelium mean?
Any pathology that affects the bladder urothelium can affect any other part of the body that has urothelium
How common is cystitis in the bladder?
Very common and rarely biopsied
What are the important variants of cystitis?
Parasites and mycotic infection, aseptic, reactive to catheters
What parasite is implicated in cystitis?
Schistosomiasis = mainly schistosomiasis haematobium, swims up the urethra, difficult to get rid of eggs
How does schistosomiasis infection cause cancer?
Persistent inflammation causes squamous metaplasia
Squamous metaplasia leads to eventual squamous cell carcinoma
What are some features of cystitis causes by catheters?
Persistent inflammation, scarring, metaplasia and squamous cell carcinoma, problematic if paraplegic
What is the old name for aseptic cystitis?
Interstitial cystitis
What occurs in aseptic cystitis?
Persistent symptoms of dysuria
Persistently negative cultures and urinalysis
Variable pathology = some inflammation, congestion, mast cells
What is cystitis cystica?
Descriptive term = infolding of bladder mucosa into cysts
How do diverticulae affect the bladder?
Not uncommon = stagnant urine, infection, stones and cancer can occur
How does bladder obstruction occur?
Prostatism = bladder muscle works hard and becomes trabeculated, eventual persistent back pressure
What occurs in urinary tract obstruction?
Back pressure = any obstruction (e.g stone, tumour)
Collecting system continues to dilate amd renal parenchyma becomes atrophic
Hydronephrosis occurs
Why can urinary tract obstruction affect the kidneys?
It is the last point in the tract
What is the aetiology of urothelial neoplasm?
Relatively common = middle aged and elderly patients, no sex predilection
What is urothelial neoplasm associated with?
Highly associated with smoking
Linked to beta-naphthyline = dye industry
What are some features of transitional cell carcinomas?
Often papillary (finger like projections) but may be CIS (flat), more concentrated in bladder but whole tract is at risk
What do adenocarcinomas occur on a background of?
Metaplasia = difficult to distinguish from colon cancer that has invaded through
What is the urachus?
Formed from the allantois
What are some features of the allantois?
Spans from dome of bladder to the umbilicus, usually involutes, may remain patent in some parts
Where does urachal adenocarcinoma affect?
Isolated to dome of the bladder
How can squamous cell carcinomas occur in the bladder when squamous epithelium doesn’t occur there normally?
Due to persistent inflammation = metaplastic epithelium is unstable and has increased risk of cancer
What is the function of the prostate?
Prostatic fluid and fluid from seminal vesicles, some contractile function during ejaculation
What can happen if the prostate gets bigger?
Due to hormonal influence = can obstruct urine flow if it occurs in the central or transitional zones
Where does hyperplasia of the prostate affect?
Mainly the central zone of the prostate = treated by trans urethral resection
How common is prostate cancer?
30% at age 50
70% at age 70
90% at age 90
What are some features of prostate cancer?
Most are low grade and slow growing so only followed up even when diagnosed
Occurs in periphery of gland usually
What are the risk factors for prostate cancer?
Cadmium batteries, less hormonal link that in benign prostatic hyperplasia, cause not clear
What is the grading system used for prostate cancer?
Gleason grading
How is Gleason grading performed?
Combination of two numbers = worst grade and predominant grade, each out of 5
Lowest is usually 3+3 (6), highest is 5+5 (10)
How is prostate cancer diagnosed?
Biopsy =transanal/rectal core biopsy
Don’t want to sample periurethrally due to peripheral location
What is PSA?
Prostate specific antigen = glycoprotein enzyme (kalkrein 3),
What is the normal function of PSA?
Liquifies semen in ejaculate and allows sperm to swim
Why is PSA not a great marker for prostate cancer?
Lacks sensitivity and specificity = raised by PR exam, riding a bike, by having a large prostate and in prostatitis
Why is PSA not produced by the worst cancers?
High grade dysplasia means that the cells of the prostate are no longer normal and can’t produce PSA
