Renal Pathology Pt. 5

Question 1

what is bladder diverticulae?

Answer 1

pouchlike evagination of the bladder wall due to increased intravesicular pressure

Question 2

what is the cause of congenital diverticulae?

Answer 2

due to focal failure of development of the normal musculature
OR
urinary tract obstruction during fetal development

Question 3

what is the cause of acquired diverticulae?

Answer 3

prostatic enlargement producing obstruction to urine flow

Question 4

which diverticulae is more common?

Answer 4

acquired

Question 5

what is the clinical significance of diverticulae?

Answer 5

creates sites of urinary stasis which predisposes the patient to infection and bladder calculi

predisposed to vesicoureteral reflux

Question 6

what is extrophy?

Answer 6

developmental failure in the anterior wall of the abdomen which allows the bladder protrude

subject to infection and increased risk of adenocarcinoma

Question 7

what predisposes an individual to vesicoureteral reflux?

Answer 7

valvular defect

Question 8

what are the classic symptoms of cystitis?

Answer 8

urinary frequency/uregency
dysuria
pelvic/abd pain
fever
dark or bloody urine

Question 9

how do you distinguish between acute uncomplicated cystitis and complicated UTI?

Answer 9

complicated UTIs typically occur in:
urinary tract abnormalities
disease states that reduce urinary tract defenses
UTIs caused by resistant pathogens

Question 10

what are the most common organisms causing cystitis?

Answer 10

E.coli
Proteus
Klebsiella
Enterobacter

Question 11

why are women more likely to develop cystitis?

Answer 11

shorter urethra

Question 12

what conditions predispose a patient to cystitis?

Answer 12

bladder calculi
urinary obstruction
DM
instrumentation (catheter)
immune deficiency

Question 13

what causes hemorrhagic cystitis?

Answer 13

cytotoxic anti-tumor drugs (cyclophosphamide)

adenovirus

Question 14

what is interstitial cystitis/Hunner ulcer?

Answer 14

chronic, persistent, painful form of cystitis

symptoms of cystitis without evidence of bacterial infection

Question 15

who is most commonly affected by interstitial cystitis?

Answer 15

women age 30-40

Question 16

what is seen on histology in interstitial cystitis?

Answer 16

mast cells and lymphocytes

inflammation and fibrosis of the bladder wall with fissures

Question 17

what is malacoplakia?

Answer 17

cystitis caused by defective phagosome function which causes chronic infection usually by E.coli

Question 18

what is seen on morphology in malacoplakia?

Answer 18

3-4 cm soft, yellow, slightly raised mucosal plaques

can also be seen in the GU tract

Question 19

who is most commonly affected by malacoplakia?

Answer 19

middle-aged females

immunocompromised patients

Question 20

what is seen on histology in malacoplakia?

Answer 20

foamy macrophages with mineralization and Michalis-Gutmann bodies
multinuclear giant cells
interspersed lymphocytes
granulomas

Question 21

what is polypoid cystitis?

Answer 21

inflammatory condition from irritation of the bladder mucosa

Question 22

what is the primary cause of polypoid cystitis?

Answer 22

indwelling catheters

Question 23

what is seen on histology in polypoid cystitis?

Answer 23

polypoid urothelium from extensive submucosal edema

Question 24

what is polypoid cystitis often misdiagnosed as?

Answer 24

papillary carcinoma

Question 25

what are cystitis cystica and cystitis glandularis?

Answer 25

chronic inflammatory conditions that occur in the setting of chronic irritation irritants are usually infection, calculi, outlet obstruction or tumor

Question 26

how are CC and CG related?

Answer 26

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

Question 27

what is follicular cystitis?

Answer 27

aggregation of lymphoid follicles in the mucosa and underlying wall typically associated with chronic infection

Question 28

what is eosinophilic cystitis?

Answer 28

infiltration of submucosal eosinophils from nonspecific subacute inflammation or systemic allergic reaction, autoimmune disorder, parasitic infection

Question 29

what is rhabdomyosarcoma?

Answer 29

malignant mesenchymal tumor typically seen in children

Question 30

what is leiomyosarcoma?

Answer 30

malignant mesenchymal tumor typically seen in adults possibly caused by radiation or chemo

Question 31

what is primary malignant lymphoma?

Answer 31

hematologic malignancy seen in adults with chronic cystitis usually non-hodgkin lymphoma

Question 32

what environmental risk factors are associated with urothelial carcinoma?

Answer 32

``` smoking industrial exposure to arylamines schistosoma hematobium analgesics cyclophosphamide radiation ```

Question 33

what genetics risk factors are associated with urothelial carcinoma?

Answer 33

Chrom 9 monosomy or deletions | Chrom 17p deletions (p53)

Question 34

what mutations are almost always seen in urothelial carcinoma?

Answer 34

TP53 and RB

Question 35

what is the clinical presentation of urothelial carcinoma?

Answer 35

painless hematuria

Question 36

what type of urothelial carcinoma has a high rate of recurrence?

Answer 36

papillary urothelial carcinoma

Question 37

what are the congenital anomalies of the penis?

Answer 37

phimosis - small penis hole hypospadias - urethral opening on ventral surface epispadias - urethral opening on the dorsal surface

Question 38

what are the congenital anomalies of the testis/epididymis?

Answer 38

cryptorchidism - incomplete descent of the testes

Question 39

what infection predisposes men to penis tumors?

Answer 39

HPV

Question 40

what is autoimmune orchitis?

Answer 40

idiopathic orchitis that presents in middle age as a tender testicular mass with fever

Question 41

what is testicular torsion?

Answer 41

twisting of the spermatic cord that cuts of venous drainage of the testis if untreated leads to testicular infarction

Question 42

what is the most common benign paratesticular tumor?

Answer 42

adenomatoid tumor

Question 43

what are the two classifications of germ cell tumors?

Answer 43

seminomatous | nonseminomatous

Question 44

what factors contribute to germ cell tumors?

Answer 44

cryptorchidism hypospadias poor sperm quality

Question 45

what genetics mutations contribute to germ cell tumors?

Answer 45

receptor tyrosine kinase KIT and BAK

Question 46

what is the precursor lesion to germ cell tumors?

Answer 46

intratubular germ cell neoplasia (ITGCN) | reduplication of chrom. 12p

Question 47

what is the most common type of germ cell tumor?

Answer 47

seminoma

Question 48

what is a spermatocytic seminoma?

Answer 48

a rare, slow-growing germ cell tumor that predominately affects older men

Question 49

what are the nonseminomatous tumors?

Answer 49

``` embryonal carcinoma yolk sac tumor choriocarcinoma teratoma mixed tumors ```

Question 50

what biomarkers are associated with germ cell tumors?

Answer 50

HCG, AFP and lactate dehydrogenase

Question 51

which germ cell tumor has a poorer prognosis?

Answer 51

nonseminomatous GCT

Question 52

what is the clinical presentation of leydig cell tumors?

Answer 52

high levels of androgens testicular swelling gynecomastia precocious puberty (children)

Question 53

what is the clinical presentation of sertoli cell tumors?

Answer 53

hormonally silent | testicular mass

Question 54

what is gonadoblasoma?

Answer 54

rare neoplasm comprised of mixture of germ cells may give rise to seminoma

Question 55

what is testicular lymphoma?

Answer 55

aggressive non-hodgkin lymphoma presenting as a testicular mass

Question 56

what are the common causes of prostatitis?

Answer 56

bacterial abacterial *most common granulomatous

Question 57

what is the primary cause of BPH?

Answer 57

nodular hyperplasia of prostatic stromal and epithelial cells that lead to urinary obstruction

Question 58

what is the most common cancer of men?

Answer 58

adenocarcinoma of the prostate

Question 59

what biomarkers can indicate prostate cancer?

Answer 59

PSA | PCA3

Question 60

what is the most common acquired genetic lesion in prostate cancer?

Answer 60

TPRSS2-ETS fusion genes that activate PI3K/AKT pathway

Question 61

what is the clinical presentation of prostate cancer?

Answer 61

often clinically silent and only detected by monitoring PSA concentrations

Question 62

what are typical signs of advanced prostate cancer?

Answer 62

osteoblastic bone mets