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Renal II Cumulative Final > Renal Path 3b > Flashcards

Renal Path 3b Flashcards

1
Q

Most common cause of hydronephrosis in infants and children

A

Ureteropelvic Junction (UPJ) obstruction

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2
Q

3 points of ureter narrowing at increased risk of renal calculi impaction

A

Ureteropelvic junction

Where they cross iliac vessels

As they enter the bladder

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3
Q

Congenital anomalies of ureters

A

Double and bifid ureters

UPJ obstruction

Diverticulae

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4
Q

Sclerosing retroperitoneal fibrosis is considered an obstructive lesion of the ureters and is considered ____-related (immunologic correlation)

A

IgG4

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5
Q

Pouchlike evaginations of the bladder wall that may arise as congenital anomalies but more commonly are acquired due to persistant urethral obstruction; d/t increased intravesical pressure, usually multiple with narrow necks

A

Diverticulae

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6
Q

Differentiate congenital from acquired diverticulae

A

Congenital form may be d/t focal failure of development of the normal musculature or to some urinary tract obstruction during fetal development

Acquired form most often seen with prostatic enlargement producing obstruction to urine outflow and thickening of bladder wall

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7
Q

Clinical significance of diverticulae

A

These are sites of urinary stasis, therefore propensity for infection and formation of bladder calculi

May also predispose to vesicoureteral reflux if they impinge on a ureter

Rarely, carcinomas may arise therein, in which case they tend to be more advanced in stage, d/t underlying thinned wall

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8
Q

Developmental failure in anterior wall of abdomen and the bladder; the latter either projects directly through a large defect to the body surface or lies as an unopened sac [M=F, W»B]

A

Exstrophy of bladder

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9
Q

Clinical significance of bladder exstrophy

A

Exposed mucosa may undergo colonic glandular metaplasia and is subject to infection that can spread to the upper GU tract

Pts have an increased risk of adenocarcinoma arising in the bladder remnant

However surgery is usually curative

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10
Q

About 1/3 of children with recurrent UTI are found to have what condition?

A

VUR — ureters enter bladder at unusual angle or length of ureter through bladder is too short —> valve malfunction —> reflux

Reflux becomes a clinical problem when urinary stasis leads to infection that subsequently involves ureter and kidney

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11
Q

A patent urachus may result in complications of infection or what type carcinoma?

A

Adenocarcinoma

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12
Q

Most common etiologic agents for acute cystitis

A

Coliforms cause 75-90%: E.coli, proteus, klebsiella, enterobacter

10-15% caused by staph saprophyticus

Much less common: mycobacteria, fungi, viruses, and protozoa, which may cause cystitis, particularly in immunocompromised

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13
Q

Predisposing factors for acute cystitis

A 
Bladder calculi
Urinary obstruction
Diabetes mellitus
Instrumentation
Immune deficiency
Radiation of bladder
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14
Q

Morphology of acute cystitis

A

Most cases exhibit non-specific inflammation

May see hyperemia of mucosa, sometimes with associated exudate

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15
Q

What type of cystitis is commonly associated with pts receiving cytotoxic anti-tumor drugs, e.g., cyclophosphamide, as well as those with adenovirus infection

A

Hemorrhagic cystitis (not associated with bacterial infection!)

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16
Q

Differentiate chronic from acute cystitis

A

Persistence of acute infection leads to chronic cystitis — differs from acute in nature of inflammatory cell infiltrate and clinical sequelae (thickened bladder wall, bladder stones)

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17
Q

Chronic, persistent, painful form of cystitis most frequently in 30-40 y/o women resulting in intermittent severe suprapubic pain, urinary frequency, urgency, hematuria, and dysuria WITHOUT evidence of bacterial infection (culture negative)

A

Interstitial cystitis (Hunner ulcer)

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18
Q

Gross and microscopic findings associated with interstitial cystitis

A

Glomerulations (petechiae)

Hunner’s ulcers

Inflammation and fibrosis of bladder wall, fissures

Varied inflammatory pattern — see MAST cells and lymphocytes

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19
Q

Peculiar pattern of bladder inflammatory reaction characterized by 3-4 cm in diameter soft, yellow, slightly raised mucosal plaques which may involve entire bladder; d/t defective phagosome function and related to chronic infection (usually E.coli)

A

Malacoplakia

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20
Q

Epidemiology of malacoplakia

A

F»M; middle aged; occurs with increased frequency in immunocompromised

Most common in bladder but can present in other organs (colon)

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21
Q

Gross and microscopic findings associated with malacoplakia

A

Marked circumferential bladder wall thickening

Inflammatory exudate and broad, flat plaques

Microscopically, infiltrates of foamy macropahges, multinuclear giant cells, and interspersed lymphocytes, in areas forming granulomas

Laminated mineralized concretions, Michaelis Gutmann bodies, are typically present in macrophages resulting from abnormal, enlarged lysosomes

22
Q

Inflammatory condition resulting from irritation of the bladder mucosa; indwelling catheters are most common underlying cause; results from extensive submucosal edema and has been misdiagnosed as papillary carcinoma

A

Polypoid cystitis

23
Q

What are cystitis cystica (CC) and cystitis glandularis (CG)?

A

CC and CG are common chronic reactive/inflammatory conditions which occur in the setting of chronic irritation

Metaplasia of the urothelium is incited by irritants such as infection, calculi, outlet obstruction, or even tumor

The urothelium proliferates into buds (nests of von Brunn) which grown down into the CT beneath the epithelium into the LP

The buds then differentiate into cystic deposits of CC or into intestinal columnar mucin-secreting glands (goblet cells) resulting in CG

The histologic features of BOTH are usually present

24
Q

Epidemiology of CC and CG

A

Can occur at any age; reported prevalence of 2.4% of children associated with UTIs

Slight male predominance

25
Q

_____cystitis is characterized by aggregation of lymphocytes in lymphoid follicles in the mucosa and underlying wall; typically associated with chronic infection

A

Follicular

26
Q

_____cystitis is manifested by infiltration of submucosal eosinophils, typically also represents nonspecific subacute inflammation, bubt rarely may be manifestation of systemic allergic reaction, autoimmune disorder, parasitic infection, or sequel to radiation or chemo

A

Eosinophilic

27
Q

Non-epithelial tumors (benign and malignant) are quite uncommon in the bladder. However, the most common of these is ______

A

Leiomyoma

28
Q

Benign vs. malignant non-epithelial urinary bladder neoplasia

A 
Benign: 
Lipoma
Fibroma
Neurofibroma
Inflammatory pseudotumor

Malignant:
Rhabdomyosarcoma (kids)
Leiomyosarcoma (adults)
Lymphoma

29
Q

Malignant mesenchymal tumor typically affecting children age 4 [m=f] with one manifestation: sarcoma botryoides

A

Embryomal rhabdomyosarcoma

30
Q

Gross vs. histo appearance of embryonal rhabdomyosarcoma

A

Tumor mass typically fills the lumen of the bladder

Histo: polypoid mass protrudes beneath flattened epithelium; cambium layer = clusters of tumor cells present immediately beneath the epithelium; result in ‘nevoid’ appearance

31
Q

Leiomyosarcoma epidemiology

A

Avg age = 60 (rare)

M > F

Sometimes follows radiation or chemotherapy

32
Q

Primary malignant lymphoma of the bladder typically affects adults, avg 65 y/o, females more likely, especially with hx of chronic cystitis. What type of lymphoma is most common?

What is the prognosis?

A

Non-Hodgkin lymphoma (diffuse large B-cell and MALT) — CD20+, Bcl-2+

Note much more common as part of systemic disease

Prognosis is good because highly radiosensitive

33
Q

Most common types of tumors of urinary bladder

A

Urothelial (transitional cell) tumors

Includes exophytic papilloma, inverted papilloma, CIS, papillary urothelial neoplasms of low malignant potential, low grade and high grade papillary urothelial cancers

34
Q

Other than urothelial tumors, what are other types of tumors that affect the urinary bladder?

A

Squamous Cell Carcinoma (many are TCC variants) — 5% of bladder cancers; include mixed carcinoma, adenocarcinoma, and small-cell carcinoma

Sarcomas (and other mesenchymal tumors) — <5% of bladder cancers

35
Q

What is PUNLMP and what is its major pathologic finding?

A

Papillary Urothelial Neoplasia of Low Malignant Potential (constitutes 15-20% of papillary tumors)

Major pathologic finding is thickened epithelium covering papillary projections and minimal cellular atypia

36
Q

There are 4 morphologic patterns of bladder (urothelial) tumors; which of the following is most common?

A. Invasive papillary carcinoma
B. Papilloma-papillary carcinoma
C. Flat noninvasive carcinoma (CIS)
D. Flat invasive carcinoma

A

B. Papilloma-papillary carcinoma

37
Q

Grading of urothelial neoplasia

A

Grade 0/I = normal; mild thickening

Grade II = atypical hyperplasia

Grade III = CIS, many progress to invade (usually preceded by flat non-invasive lesions)

38
Q

Epidemiology of urothelial carcinoma

A

Males more common

White males at highest risk

Industrial > non-urban > rural

73 years = median age at dx, but 25% < 65 y/o

Painless hematuria is the dominant, and usually ONLY clinical finding

Uncommonly, ureteral orifice may be blocked by tumor causing acute pyelonephritis or unilateral hydronephrosis

Frequently multiple tumors at time of dx

39
Q

Risk factors for urothelial carcinoma

A

Cigarette smoking (3-7x risk!!)

Industrial exposure to arylamines

Schistosoma hematobium (also leads to SCC!)

Long term analgesic use

Long term exposure to cyclophosphamide (nitrogen mustard)

Radiation

40
Q

Genetic factors associated with urothelial carcinoma — which one is particularly bad prognostic sign?

A
  1. Chr 9, monosomy or deletions (30-60%), seen in many superficial and non-invasive, as well as some invasive
  2. Chr 17p deletions, invasive and CIS (p53)

p53 is particularly bad prognostic signq

41
Q

Major prognostic factors that must be established in bladder cancer

A

Stage is critical prognostic factor

Depth of muscle invasion is the MAJOR prognostic issue to be established

42
Q

Congenital anomalies of the penis

A

Atypical locations for distal urethra = hypospadias, epispadias

Phimosis = glans becomes ischemic d/t prepuce being too tight

43
Q

Histology of venereal wart likely shows ______ aka clearing of cytoplasm and pyknotic nuclei

A

Koilocytosis

44
Q

What type of carcinoma of the penis is associated with poor genital hygiene and high-risk HPV infection; also associated with circumcision as a protective factor?

A

SCC

45
Q

Complete or partial failure of intraabdominal testes to descend into scrotal sac

A

Cryptorchidism

[likely to be accompanied by other anomalies of GU tract like hypospadias]

46
Q

Causes of inflammation of testis and epididymis

A

Granulomatous (autoimmune) orchitis

Specific inflammaions: Gonorrhea, Mumps, TB, Syphilis

47
Q

Most common solid tumor in men

A

Testicular germ cell tumors (either seminomas or non-seminomas)

48
Q

Approximately 15% of seminomas contain _____, in this subset of patients, serum ____ levels are elevated, though not to the extent seen in pts with choriocarcinoma

A

Syncytiotrophoblasts; HCG

49
Q

Testing for alpha-fetoprotein is looking for what type of nonseminomatous germ cell tumor?

A

Yolk sac tumors

50
Q

What type of cancer’s prognosis is measured by Gleason score?

A

Prostate carcinoma [gleason of 10 = the worst]

51
Q

Prostate cancer may spread via ______ invasion, which allows it to metastasize to bone, usually the ______

A

Perineural; spine

52
Q

Biomarkers for prostate cancer

A

PSA (nonspecific)

PCA3 in urine

TMPRSS2-ERG fusion DNA in urine

Renal II Cumulative Final (20 decks)

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