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MHD II Test 3 > Pathology of the Lower Urinary Tract and Male Genital System I > Flashcards

Pathology of the Lower Urinary Tract and Male Genital System I Flashcards

1
Q

Urothelium

  1. How many layers?
  2. What kind of cells are there?
  3. What layers are underneath it?
A
  1. 5-7 layers
  2. umbrella (superficial), intermediate, basal
  3. Lamina propria (loose connective tissue, delicate bundles of smooth muscle fibers-muscularis mucosae), and Muscularis propria (deep muscle, destrusor muscle, arranged in several layers)
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2
Q

Urothelium

  1. Function
  2. What ability does it have to carry out this functions?
A
  1. urine-blood barrier

2. tight junctions and desmosomes that allow it to dilate and contract while keeping the barrier intact

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3
Q

Ureter Congenital Abnormalities

  1. How common?
  2. What can an obstruction cause?
  3. What do pts with double ureters have?
  4. What is the most common cause of hydronephrosis in children?
  5. What can occur when there is a defect of ureteral muscle? (2)
A
  1. 2-3% of all autopsies
  2. reflux –> inflammation –> pyelonephritis
  3. double renal pelvis, bifid pelvis
  4. ureteropelvic junction obstruction (can also be acquired in young women)
  5. diverticula, megaureter
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4
Q

Ureteritis/Cystitis Cystica

  1. How do they occur?
  2. Gross look?
  3. Micro look?
  4. Malignant potential?
A
  1. urothelium invaginates into the lamina propria and forms von Brunn’s nests w/ degenerated central cells to form small cystic cavities
  2. translucent, submucosal, pearly-yellow cysts, usually up to 5 mm
  3. glandular metaplasia, cystic formation
  4. benign
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5
Q

Causes of UT Obstructions

  1. Intrinsic (5)
  2. Extrinsic (5)
A
  1. calculi, strictures, tumors, blood clots, neurogenic

2. pregnancy, periureteral inflammation, endometriosis, retroperitoneal fibrosis, tumors

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6
Q

Urinary Bladder- Congenital Abnormalities

  1. What is Exstrophy?
  2. What is Vesicoureteral reflux?
A
  1. developmental failure in the anterior wall of the abdomen and in the bladder- bladder sits exposed to outer elements; undergoes metaplasia which can –> adenocarcinoma
  2. Valve defect allows urine from the bladder to reflux back into the kidney and predisposes it to hydrnephrosis
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7
Q

Acute and Chronic Cystitis

  1. Define
  2. Who tends to get it? Why?
  3. What are some predisposing factors?
  4. What bacteria cause it?
  5. Symptoms
  6. Treatment
A
  1. bladder inflammation
  2. women, short urethra
  3. bladder calculia, urinary obstruction, diabetes mellitus, instrumentations, immune deficiency
  4. E coli, Proteus, Klebsiella, Enterobacter, Staph saprophyticus
  5. Frequency, pain (lower abdomen), dysuria (painful urination), fever
  6. Bactrim
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8
Q

Interstitial Cystitis

  1. AKA
  2. Define
  3. Who tends to get it? What age?
  4. Associated with what? (2)
A
  1. Chronic Pelvic Pain Syndrome
  2. Non-bacterial form of cystitis (negative cultures and cytology)
  3. 90% females, 30-50
  4. allergies, autoimmune diseases (SLE, RA, thyroiditis)
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9
Q

Interstitial Cystitis

  1. Symptoms
  2. Cytoscopic findings
  3. Histo findings
  4. Treatment
  5. What must be ruled out?
A
  1. intermittent, often severe, suprapubic pain, urinary frequency, urgency, hematuria, and dysuria
  2. fissures and punctate hemorrhages
  3. inflammation, neutrophils; some have chronic mucosal ulcers (Hunner’s ulcer), mast cells may be seen
  4. Empiric, treat symptoms
  5. carcinoma in situ
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10
Q

Malakoplakia

  1. Define
  2. Symptoms
  3. Cytoscopy
  4. Histology
A
  1. inflammatory condition that presents as a papule/nodule
  2. recurrent fever, bladder irritability, pain, hematuria, pyuria, weight loss
  3. multiple raised soft yellow to brown plaques and nodules
  4. dense infiltrate of large foamy macrophages with finely granular eosinophilic cytoplasm (von Hansemann histiocytes) and blue targetoid calcospherules (Michaelis-Gutmann bodies); Fe and Ca depositions
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11
Q

Malakoplakia

  1. Who tends to get it?
  2. Related to what?
  3. Where else can it present?
A
  1. females, fifth decade
  2. chronic bacterial infection (E. coli)
  3. colon, lung, kidney, other GU sites
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12
Q

Leukoplakia

  1. What is it?
  2. Etiology
  3. What can happen if it is extensive?
  4. Risk factor for what?
  5. Gross look
  6. Histo look
A
  1. squamous metaplasia
  2. long term irritation or chronic infection- stones, nonfunctioning bladders, schistosomiasis
  3. may interfere with contraction and dilatation
  4. development of carcinoma
  5. gray-white areas (due to keratin)
  6. keratinizing squamous epithelium
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13
Q

Bladder Cancer

  1. What is the good news/bad news?
  2. Which gender gets it more? Average age?
  3. Bladder is most common site for what?
  4. Presentation
A
  1. most are superficial- easy to treat; have a high recurrence rate, so must follow up
  2. male; 65
  3. urothelial carcinoma
  4. painless hematuria; irritative symptoms (dysuria, frequency, urgency)- in high grade carcinomas; flank pain, bone pain, pelvic mass
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14
Q

Etiology of Bladder Cancer

A 
Cigarette Smoking (high risk)
Arylamines (found in dye products)
Chronic cystitis (schistosomiasis, UTI, indwelling catheter, urolithiasis)
Cyclophosphamide- acrolein metabolite
Long term analgesic usage (phenacetin)
Pelvic Irradiation
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15
Q

Pathogenesis

  1. 90% are…
  2. 10% are…
  3. Mutations in the 90%
  4. Mutations in the 1%
A
  1. dysplasia (flat, noninvasive carcinoma)
  2. hyperplasia (papillary urothelial hyperplasia)
  3. RAS
  4. RB, p53
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16
Q

Bladder Cancer

  1. 2 Morphologic patterns
  2. What is staging based on?
  3. What does low grade urothelial Carcinoma in Situ look like?
  4. What does high grade urothelial Carcinoma in Situ look like?
A
  1. Papilloma or Flat (areas of red velvety patches)
  2. Depth of invasion
  3. oriented vertically, low nucleus/cytoplasm ratio
  4. large, oriented in every direction;
17
Q

Papillary Urothelial Carcinoma, Low Grade

  1. Histo look
  2. How much nuclear atypia?
  3. Recurrence rate
  4. Progression rate
  5. How helpful is cytology?
  6. Treatment
A
  1. orderly appearance, both architecturally and cytologically
  2. minimal
  3. 50%
  4. 10%
  5. Not very, can’t be distinguished from other cells; stay diploid
  6. resect, follow up
18
Q 
Papillary Urothelial Carcinoma, high grade
1 Histo look (3 things)
4. invasion rate
5. How helpful is cytology?
6. Treatment
A
  1. discohesive, large hyperchromatic nuclei (higher cytoplasm/nucleus ratio)
  2. disarray with loss of polarity
  3. mitotic figures, including atypical ones
  4. 80%,
  5. helpful, can distinguish/ID cancer from other cells
  6. Chemo
19
Q

Bacillus Calmette-Guerin

  1. What is it?
  2. What is it used for?
  3. Why?
  4. Designed to do what? (2)
A
  1. attenuated strain of Mycobacterium tb
  2. intravesical BCG immunotherapy is one of the most widely used approaches to manage superficial bladder cancer
  3. elicits a local cell-mediated immune reaction that destroys tumors
  4. treat established disease and prevent recurrence
20
Q

Bladder Cancer Prognosis

  1. Low grade papillary lesions
  2. High grade papillary carcinoma
  3. Invasive carcinoma (in lamina propia)
A
  1. > 98% 10yr survival
  2. 75%
  3. 30%
21
Q

Name other epithelial tumors of the bladder (3)

A

Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma

22
Q

Mesenchymal Tumors of the Bladder

  1. How common?
  2. Which is most common in infancy?
  3. Which is most common in adults?
A
  1. exceedingly rare
  2. embryonal rhabdomyosarcoma
  3. Leiomyosarcoma
23
Q 
Urethra
1. 2 common causes of urethritis
Tumor and Tumor-Like Lesions
2. What is a Caruncle?
3. What is Peyronie disease?
4. Common carcinomas?
A
  1. nongonococcal- E. coli; gonococcal: n. gonorrheae
  2. inflamed granulation tissue polyp
  3. fibrous bands involving corpus cavernosum of the penis
  4. proximal urothelial, distal squamous
24
Q

Prostate

  1. 2 normal cells
  2. 2 main causes of inflammation
  3. How is this determined?
A
  1. Secretory cells and basal cells
  2. bacterial (acute and chronic) and abacterial
  3. bacterial cultures and microscopic examination of fractionated urine
25
Q

Benign Prostatic Hyperplasia (BPH)

  1. Define
  2. How common?
  3. Symptoms
  4. Etiology
A
  1. hyperplasia of prostatic glands and stroma
  2. extremely common;
  3. compression of urethra (difficulties w/ urination), retention of urine in the bladder (–> distention and hypertrophy, cystitis, pyelonephritis) (only 30% have moderate to severe symptoms)
  4. DHT (converted from testosterone by 5 alpha reductase) can act in an autocrine loop on prostate secretory cells
26
Q

BPH

  1. Gross look
  2. Histo look
A
  1. Prostatic enlargement due to presence of nodules in the preprostatic region (periurethral, transitional zone)
  2. nodularity due to proliferation or dilatation of glandular component and muscular proliferation of the stromal component
27
Q

Prostate Cancer

  1. What kind?
  2. How common?
  3. Who tends to get it?
A
  1. adenocarcinoma
  2. most common cancer in men, second leading cause of cancer related death in men (ppl tend to die w/ PCA than of PCA)
  3. incidence increases w/ age, African ancestry>European ancestry>Asian ancestry; may be diet related
28
Q

Prostate Cancer- Molecular bio

  1. Role of Androgen Receptor
  2. Role of BRCA2
  3. ETS gene
  4. What is the most common epigenetic alteration in PCA?
  5. Biomarkers of PCA (4; 2 impt ones)
A
  1. contains a polymorphic sequence composed of CAG repeats; pts w/ shortest CAG repeats have highest androgen sensitivity (often African Americans)
  2. germline mutation; 20 fold increase for PCA
  3. Somatic mutation resultis in chromosomal rearrangement placing ETS gene under control of TMPPRSS2 promoter
  4. hypermethylation of gluthation S-transferase which downregulates the gene chr 11q
  5. AMACR, PSA (prostate specific Ag), EZH-2, PCA3
29
Q

Prostate Specific Antigen (PSA)

  1. What is it?
  2. What cells produce it?
  3. When is it elevated?
  4. What reduces it? (3)
  5. What is the upper limit of normal?
A
  1. serine protease composed of single-chain glycoprotein
  2. epithelial cells or normal, hyperplastic, and cancerous prostate tissue
  3. in pts w/ prostate cancer, BPH, prostatitis, trauma, infarct, DRE, ejaculation; increases with age
  4. 5 alpha reductase inhibitors, androgen deprivation, prostatectomy
  5. 4 ng/ml
30
Q
  1. Define PSA density
  2. Define PSA velocity
  3. What else is measured?
A
  1. ratio between the serum PSA and volume of prostate gland
  2. rate of change in PSA value with time
  3. Ratio of free and bound PSA
31
Q

Prostatic Intraepithelial Neoplasia (PIN)

  1. What is it?
  2. Is it invasive?
  3. What is it associated with?
A
  1. proliferation of neoplastic cells w/in large ducts
  2. does not progress to invasive carcinoma
  3. other carcinomas
32
Q

Prostate Carcinoma (PCA)

  1. Gross Features (3)
  2. Histo Features (5)
  3. Gleason Grading System
  4. What is 3 good at?
A
  1. palpably hard, tan/white nodule; posterolateral portion of gland; most often tumor not grossly visible
  2. small glands w/ infiltrative pattern, nuclear enlargement, prominent nucleoli, single-cell layer, perineural invasion, intracytoplasmic mucins, crystals
  3. 1-10: primary (most common) grade + secondary (2nd most common) grade
  4. best marker to predict prognosis
33
Q

PCA Staging

  1. What does T1 mean?
  2. T2?
  3. T3?
  4. T4?
  5. N1?
  6. M1?
A
  1. clinically inapparent lesion (dx on core biopsy)
  2. confined to prostate
  3. local extraprostatic extension
  4. surrounding organs
  5. presence in lymph nodes
  6. metastasis
34
Q

PCA Treatment

  1. Confined to prostate
  2. Alternative?
  3. Advanced or metastatic disease?
A
  1. Radical prostatectomy
  2. Radiation
  3. Androgen deprivation

MHD II Test 3 (14 decks)

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