Pathology of lower urinary tract II Flashcards
How can bladder tumors be classified
urothelial
squamous cell carcinoma
adenocarcinoma
bladder tumors are the most common type of malignancy in what system
urinary system
what are the risk factors for bladder tumors
Smoking
exposure to dye, rubber, and leather industries
older age
chronic bladder infections
older age
gender (men)
family history
HPV
radiation, cyclosphosphamide
analgesics
what are common symptoms of bladder tumor
hematuria
frequent urination
painful urination
pelvic or lower back pain
How do you diagnose bladder tumors
urine test
imaging test
cytoscopy
biopsy
How do you treat bladder tumors
radial cystectomy
chemotherapy (IVesical via bladder or systemic via blood)
immunotherapy
radiation
What are the subtypes of urothelial cancers
Papillary urothelial neoplasms with low malignant potential (PUNLMP)
Non-invasive papillary urothelial carcinoma
urothelial carcinoma in situ
invasive urothelial carcinoma
Papillary urothelial neoplasms with low malignant potential (PUNLMP)
a papillary urothelial growth with an increased layer of urothelium
slow growing and less aggressive
common on lateral posterior walls and ureteric orifices
asymptomatic or hematuria
what is the histology of PUNLMP
an orderly arrangement of cells within papillae with minimal architectural abnormalities and minimal nuclear atypia
thicker epithelium and in increased nuclear size/hyperchromasia
Non-invasive papillary urothelial carcinoma (low grade)
has slight architectural abnormality and distinct but low grade cytologic atypia
no high grade features
multicentric
what is the histology of non-invasive papillary urothelial carcinoma (low grade)
slightly disorganized architecture and mild variation in nuclear shape, size, and darkness
Non-invasive papillary urothelial carcinoma (high grade)
papillary growth with moderate to marked architectural and cytologic aatypia
high rate of progression of to invasive disease
often aneuplodiy, p53, HER2, EGFR
hematuria, urinary symptoms
What is the histology of Non-invasive papillary urothelial carcinoma (high grade)
moderate to marked architectural and cytological pleomorphism
complex papillary fronds lined by urothelium with marked cyologic atypia including nuclear pleomorphism, loss or polarity and apoptosis
urothelia carcinoma in situ
flat urothelial lesion composed of cells in mild to upper urothelium with high cytologic grade
multifocal
tumor cells easily shed in urine
how can you treat urothelia carcinoma in situ
bCG, complete excision is curative
invasive urothelial carcinoma
can be low or high grade
most common bladder tumor
4th most common cancer in american males
what are the risk factors for invasive urothelial carcinoma
cigarette smoking
industrial exposure
cyclophosphamide
chronic irritation
HPV
What is the clinical presentation of invasive urothelial carcinoma
painless hematuria
obstruction if near uretal orifices
irritative bladder symptoms
how is genetics affect invasive urothelial carcinoma
aneuploidy
Low grade; FGFR3
High grade: p53
What are the two pathways of urothelial carcinoma
Flat
Papillary
Flat pathway of the urothelial carcinoma
develops as high grade flat tumor then invades
associated with early p53 mutation
Papillary pathway of the urothelial carcinoma
develops as low grade papillary tumor that progresses to a high grade papillary tumor and then invades
not associated with early p53 mutation
Squamous cell carcinoma
arises after squamous metaplasia urinary tract does not have squamous cells)
Adenocarcinoma
Malignant tumor with gland cells
more common in men
may be associated with intestinal metaplasia - chronic irritation of the bladder
