Robbins Ch. 21 - Lower UT and Male Genital System II

Question 1

95% bladder tumors

Answer 1

of epithelial origin (urothelial = transitional cell)

Question 2

urothelial tumors

Answer 2

many multifocal

Question 3

precursor lesions to invasive urothelial carcinoma

Answer 3

noninvasive papillary tumors (more common)
-papillary urothelial hyperplasia

flat noninvasive urothelial carcinoma
-carcinoma in situ

Question 4

CIS

Answer 4

carcinoma in situ

-malignancy with no invasion of basement membrane

Question 5

invasion of muscularis propria

Answer 5

worst prognosis for bladder carcinoma

30% 5 year mortality rate

Question 6

carcinoma of the bladder

Answer 6

more in men

• 50-80yo
• not familial

tobacco use - increased risk 3-7x
industrial exposure - aryl amines
schistosoma hematobium infection increases risk
long term analgesic use
cyclophosphamide use
irradiation

Question 7

gain of function FGFR3

Answer 7

noninvasive low-grade papillary carcinomas

Question 8

loss of function TP53 and RB tumor suppressor genes

Answer 8

high grade and muscle invasive tumors

Question 9

activating mutation of GRAS

Answer 9

low grade non-invasive tumor

Question 10

loss of chromosome 9

Answer 10

superficial noninvasive papillary tumors

occasionally noninvasive flat tumors

Question 11

FGFR3 and RAS mutations and chromosome 9 deletion

Answer 11

low-grade superficial papillary tumors

-if lose TP53 or RB - progress to invasion

Question 12

morph of urothelial tumors

Answer 12

most from lateral or posterior bladder wall

papilllary - red, elevated, 1-5cm

Question 13

papillomas

Answer 13

<1% of bladder tumors

• typically younger patients
• 0.5-2cm
• delicate structures - attached to mucosa by stalk
• referred to as exophytic papillomas**
• central core of fibrovascular tissue - covered by normal ureothelium

Question 14

inverted papillomas

Answer 14

benign

-inter-anastomosing cord of urothelium extending down into lamina propria

Question 15

papillary urothelial neoplasms of low malignant potential

Answer 15

thicker urothelium

• larger than papillomas
• may progress

Question 16

low-grade papillary urothelial carcinoma

Answer 16

evenl spaced and cohesive
-nuclear atypia - scattered hyperchromatic nuclei, infrequent mitotic figures, variation in nuclear size and shape

• may recur and may invade (10%)
• rarely pose a threat

Question 17

high-grade papillary urothelial cancers

Answer 17

dyscohesive cells - large hyperchromatic nuclei

• anaplastic
• atypical mitotic figures
• disarray of cells
• much higher incidence of invasion (80%)
• increased risk of progression

Question 18

40% deeply invasive tumors

Answer 18

mets to lymph nodes

-hematogenous spread to liver, lungs, bone marrow

Question 19

flat urothelial carcinoma

Answer 19

CIS
-malignant cells within flat urothelium

• full thickness or pagetoid spread (scattered cells)
• lack of cohesiveness - shed malignant cells in urine

appears - mucosal reddening, granular, thickened

commonly multifocal

50-75% to invasive cancer if untreated

Question 20

invasive urothelial cancer

Answer 20

staging at initial diagnosis - important for patient outlook

Question 21

squamous cell carcinomas

Answer 21

3-7% bladder cancers

-chronic bladder irritation and infection

Question 22

mixed urothelial carcinomas

Answer 22

with areas of squamous carcinoma

-more frequent than pure squamous cell carcinomas

Question 23

adenocarcinomas

Answer 23

of bladder - rare

may be associated with urachal metaplasia

Question 24

small cell carcinomas

Answer 24

identical to those in lungs

Question 25

bladder cancer - clinical

Answer 25

painless hematuria

• possible frequency, urgency, dysuria
• 60% - single
• 70% - localized to bladder

Question 26

urothelial tumor clinical

Answer 26

tendency to recur - possibly higher grade

Question 27

cancer prognosis

Answer 27

depend on grade and stage

• papillary urothelial neoplasms and low-grade papillary urothelial cancer - 98% 10 year survival
• high-grade papillary urothelial cancer - death 25 % patients

primary CIS (no urothelial carcinoma) - 28% invasive

secondary CIS - 59% invasive

invasive urothelial carcinoma - 30% mortality once invades lamina propria

Question 28

bacillus calmette guerin

Answer 28

intra vesical instillation of mycobacterium bovis

• local inflammation that destroys tumor
• for patients at high risk of recurrence

Question 29

radical cystectomy

Answer 29

reserved for tumors invading lamina propria, CIS or high grade refractory to BCG, CIS extending into prostatic urethra

Question 30

benign tumors

Answer 30

most common - leiomyoma

Question 31

sarcoma

Answer 31

uncommon in bladder

most common in adults - leiomyosarcoma

Question 32

loss of TP53 and RB

Answer 32

high grade (papillary or flat)

Question 33

gain of FGFR3 and HRAS

Answer 33

low grade papillary

Question 34

bladder obstruction

Answer 34

eventual effect on kidney

• males - BPH
• females - cystocele

Question 35

morphology of bladder obstruction

Answer 35

thickened bladder wall - smooth m. hypertrophy

-over time - crypts > diverticuli

Question 36

urethritis

Answer 36

separated to:

• gonococcal
• non-gonococcal - chlamydia (majority), myclplasm

Question 37

urethral caruncle

Answer 37

small, red, painful mass at end of urethral meatus

• older females
• granulation tissue - deilcate
• Tx - surgical excision

Question 38

proximal urethra carcinoma

Answer 38

urothelial carcinoma

Question 39

distal urethra carcinoma

Answer 39

squamous cell carcinomas