Renal Pathology Pt. 5 Flashcards
what is bladder diverticulae?
pouchlike evagination of the bladder wall due to increased intravesicular pressure
what is the cause of congenital diverticulae?
due to focal failure of development of the normal musculature
OR
urinary tract obstruction during fetal development
what is the cause of acquired diverticulae?
prostatic enlargement producing obstruction to urine flow
which diverticulae is more common?
acquired
what is the clinical significance of diverticulae?
creates sites of urinary stasis which predisposes the patient to infection and bladder calculi
predisposed to vesicoureteral reflux
what is extrophy?
developmental failure in the anterior wall of the abdomen which allows the bladder protrude
subject to infection and increased risk of adenocarcinoma
what predisposes an individual to vesicoureteral reflux?
valvular defect
what are the classic symptoms of cystitis?
urinary frequency/uregency dysuria pelvic/abd pain fever dark or bloody urine
how do you distinguish between acute uncomplicated cystitis and complicated UTI?
complicated UTIs typically occur in:
urinary tract abnormalities
disease states that reduce urinary tract defenses
UTIs caused by resistant pathogens
what are the most common organisms causing cystitis?
E.coli
Proteus
Klebsiella
Enterobacter
why are women more likely to develop cystitis?
shorter urethra
what conditions predispose a patient to cystitis?
bladder calculi urinary obstruction DM instrumentation (catheter) immune deficiency
what causes hemorrhagic cystitis?
cytotoxic anti-tumor drugs (cyclophosphamide)
adenovirus
what is interstitial cystitis/Hunner ulcer?
chronic, persistent, painful form of cystitis
symptoms of cystitis without evidence of bacterial infection
who is most commonly affected by interstitial cystitis?
women age 30-40
what is seen on histology in interstitial cystitis?
mast cells and lymphocytes
inflammation and fibrosis of the bladder wall with fissures
what is malacoplakia?
cystitis caused by defective phagosome function which causes chronic infection usually by E.coli
what is seen on morphology in malacoplakia?
3-4 cm soft, yellow, slightly raised mucosal plaques
can also be seen in the GU tract
who is most commonly affected by malacoplakia?
middle-aged females
immunocompromised patients
what is seen on histology in malacoplakia?
foamy macrophages with mineralization and Michalis-Gutmann bodies
multinuclear giant cells
interspersed lymphocytes
granulomas
what is polypoid cystitis?
inflammatory condition from irritation of the bladder mucosa
what is the primary cause of polypoid cystitis?
indwelling catheters
what is seen on histology in polypoid cystitis?
polypoid urothelium from extensive submucosal edema
what is polypoid cystitis often misdiagnosed as?
papillary carcinoma
what are cystitis cystica and cystitis glandularis?
chronic inflammatory conditions that occur in the setting of chronic irritation
irritants are usually infection, calculi, outlet obstruction or tumor
how are CC and CG related?
urothelium proliferates into buds which grow into CT beneath the epithelium into the lamina propria
the buds then differentiate into cystic depositions of CC or into intestinal columnar mucin-secreting glands resulting in CG
both forms are usually found on histo
what is follicular cystitis?
aggregation of lymphoid follicles in the mucosa and underlying wall
typically associated with chronic infection
what is eosinophilic cystitis?
infiltration of submucosal eosinophils from nonspecific subacute inflammation or systemic allergic reaction, autoimmune disorder, parasitic infection
what is rhabdomyosarcoma?
malignant mesenchymal tumor typically seen in children
what is leiomyosarcoma?
malignant mesenchymal tumor typically seen in adults
possibly caused by radiation or chemo
what is primary malignant lymphoma?
hematologic malignancy seen in adults with chronic cystitis
usually non-hodgkin lymphoma
what environmental risk factors are associated with urothelial carcinoma?
smoking industrial exposure to arylamines schistosoma hematobium analgesics cyclophosphamide radiation
what genetics risk factors are associated with urothelial carcinoma?
Chrom 9 monosomy or deletions
Chrom 17p deletions (p53)
what mutations are almost always seen in urothelial carcinoma?
TP53 and RB
what is the clinical presentation of urothelial carcinoma?
painless hematuria
what type of urothelial carcinoma has a high rate of recurrence?
papillary urothelial carcinoma
what are the congenital anomalies of the penis?
phimosis - small penis hole
hypospadias - urethral opening on ventral surface
epispadias - urethral opening on the dorsal surface
what are the congenital anomalies of the testis/epididymis?
cryptorchidism - incomplete descent of the testes
what infection predisposes men to penis tumors?
HPV
what is autoimmune orchitis?
idiopathic orchitis that presents in middle age as a tender testicular mass with fever
what is testicular torsion?
twisting of the spermatic cord that cuts of venous drainage of the testis
if untreated leads to testicular infarction
what is the most common benign paratesticular tumor?
adenomatoid tumor
what are the two classifications of germ cell tumors?
seminomatous
nonseminomatous
what factors contribute to germ cell tumors?
cryptorchidism
hypospadias
poor sperm quality
what genetics mutations contribute to germ cell tumors?
receptor tyrosine kinase KIT and BAK
what is the precursor lesion to germ cell tumors?
intratubular germ cell neoplasia (ITGCN)
reduplication of chrom. 12p
what is the most common type of germ cell tumor?
seminoma
what is a spermatocytic seminoma?
a rare, slow-growing germ cell tumor that predominately affects older men
what are the nonseminomatous tumors?
embryonal carcinoma yolk sac tumor choriocarcinoma teratoma mixed tumors
what biomarkers are associated with germ cell tumors?
HCG, AFP and lactate dehydrogenase
which germ cell tumor has a poorer prognosis?
nonseminomatous GCT
what is the clinical presentation of leydig cell tumors?
high levels of androgens
testicular swelling
gynecomastia
precocious puberty (children)
what is the clinical presentation of sertoli cell tumors?
hormonally silent
testicular mass
what is gonadoblasoma?
rare neoplasm comprised of mixture of germ cells
may give rise to seminoma
what is testicular lymphoma?
aggressive non-hodgkin lymphoma presenting as a testicular mass
what are the common causes of prostatitis?
bacterial
abacterial *most common
granulomatous
what is the primary cause of BPH?
nodular hyperplasia of prostatic stromal and epithelial cells that lead to urinary obstruction
what is the most common cancer of men?
adenocarcinoma of the prostate
what biomarkers can indicate prostate cancer?
PSA
PCA3
what is the most common acquired genetic lesion in prostate cancer?
TPRSS2-ETS fusion genes that activate PI3K/AKT pathway
what is the clinical presentation of prostate cancer?
often clinically silent and only detected by monitoring PSA concentrations
what are typical signs of advanced prostate cancer?
osteoblastic bone mets
