The Lower UT and Male Repro System Flashcards
What causes Exstrophy of the bladder
Incomplete resorption of the anterior cloacal membrane which is nomrlaly replaced by smooth muscle in embryogenesis
What can failiure of the urachus to involute lead to ?
Vesicle-umbilical fistula or urachal diverticulum
What cancer is likely to develop from exstrophy of the bladder?
Squamous Carcinoma (from squamous metaplasia of exposed bladder mucosa)
What complications result form Nodular Prostatic Hyperplasia?
UTI from retention of urine in the bladder
Bladder Diverticula
Bladder stones from retained urine in a diverticulum becoming infected
Bladder Infection Risk is increased with what?
Bladder Calculi Bladder Outlet Obstruction DM Immunodeficiency Prior instrumentation or catheterization Radiation therapy Chemotherapy
What microscopical findings are associated with acute cystitis?
Stromal edema
hemorrhage
Neutrophlic infiltrate of variable intensity
What is typical presentation of urothelial cell carcinoma?
Sudden Hematuria
less frequently, Dysuria
What is typical presentation of chronic cystitis?
Dysuria (pain when urinating)
Excessive urinary frequency
Lower abdominal or pelvic discomfort
Microscopic: Predominance of lymphocytes and fibrosis of the lamina propria
Describe an Exophytic Papilloma
Papillary fronds that are lined by urothelial epithelium (indistinguishable from normal urothelium)
Usually a single lesion 2-5 cm in diameter, although multiple papillomas are not unusual
UROTHELIAL CELL CARCINOMA IN SITUE
RED VELVETY FLAT PATCHES (close to expohytic papillary urothelial cell carcinoma)
What are the most important risk factors for bladder cancer?
Cigarette Smoking Industrial Exposure to Azo Dyes Infection with Schistosoma Haematobium Drugs (Cyclophosphamide and analgesics) Radiation Therapy (prostate, cervical, rectal cancer)
What is hydrocele associated with in infants? adults?
Infants- Inguinal Hernia
Adults0 Infection, Tumor, or Trauma
What can cause Hematocele?
Testicular Tumors
Trauma
Can develop into hydrocele
What does “field effect” refer to in regards to urotthelial cell carcinoma?
The etiologic factors associated with epithelial tumors of the renal pelvis and ureter are similar to those observed in bladder cancer
How does Rhabdomyosarcoma typically of the embryonal type manifest?
Mostly in children as SARCOMA BUTYROIDES
These are edematous, mucosal, polypoid masses that resemble a “cluster of grapes”
What are Urethral Caruncles? Which patients are affected
Polylpoid inflammatory lesions containing acutely and choronically inflamed granulation tissue, ulceration, and hyperplasia of urothelial or squamous epithelium.
The lesion is usually near the urethral meatus and produces pain and bleeding
The polypoid mass is exophytic, often ulcerated
This is mostly seen in women, mostly after menopause
How is the pronosis of squamous cell carcinoma of the bladder?
Poor- almost all patients with this tumor demonstrate invasion of the bladder wall at the time of initial presentation
What lesions develop from HPB?
Wart-like lesions- referred to as VERRUCAE and CONDYLOMATA
Lesion shows epidermal hyperkeratosis, parakeratosis, acanthosis, papillomatosis
What causes Balanoposthitis?
It is caused by bacterial infection, but in immunosuppressed persons and in diabeetics, it can also be caused by fungi. It is a typically a consequence of poor hygiene in uncircumcised men.
What are complications of Balanoposthitis?
- Stricture of the meauts, phimosis, and paraphimosis
- Phimosis
What is Phimosis? Paraphimosis?
The orifices of the prepuce may be too narrow to allow retraction over the glans penis.
When the narrow prepuce is forcefully retracted, it may strangulate the glans and impede the outflow of venous blood.
What are is the pathogenesis of BPH?
Mostly due to age0related changes in circulatingl evels of testosterone and dihyrotestosterone.
approximately 75% of men 80yo + have some degree of BPH
What is the typical presentation of Epididymitis?
Intrascrotal pain and tenderness, with or without associated fever
What is associated with Female Pseudohermaphroditism?
Virilization of the external genital organs
Virilization of Vulva: Fusion into scrotal folds and is associated with clitoromegaly (most often seen in adrenogenital syndrome caused by 21-OHase deficiency- also adrenal hyperplasia and ambiguous genitalia is seen with this deficiency)
What characterizes Male Psuedohermaphroditism? When does this normally occur?
- A normal 46, XY karyotype
- Gonads are cryptorchid testes, but the external genital organs appear feminine or ambiguously female, with signs of virilization
Most often encountered in androgen-insensitivity syndromes due to a congenital deficiency of the androgen receptor, also known as testicular feminization syndrome.
What is most common testicular tumor in the first 4 years of life? 4-12 yrs of life? Adults?
60yo): Malignant Lymphoma
What is the microscopic appearance of a Yolk sac tumor?
- Interlacing strands of epithelial cells surrounded by loose connective stroma
- Lobular arrangement of cells, surrounded by empty spaces, leads to the formation of glomeruloid structures referred to as Schiller-Duval bodies
What cancer secretes hCG?
Chorocarcinoma
Describe a Seminoma on gross exam? micro?
Gross: Solid, rubbery-firm masses
Micro: Neoplastic cells arranged as nests or sheets that are separated by fibrous septae and infiltrated with chronic inflammatory cells (lymphocytes, plasma cells, and macrophages)
What pathology is seen with Mumps Infection?
Orchitis in males
Testicular Pain and Gonadal swelling (most commonly unilateral)
What is Klinefelter Syndrome?
Cause: Meiotic Nondisjunction during oogenesis
Patients have 47 , XXY karyotype (1 in 25 patients have 4, XX) and are infertile
Patients typically have testicular atrophy and loss of meiotic and postmeiotic germ cells. Patients also have hypoandrogenism
Where does early nodular hyperplasia of the prostate begin ?
In the region of the proximal urethra (the urothelial zone)
In well-developed cases, the normal prostate gland is limited to an attenuated rim of tissue beneath the capsule
What is the most frequently diagnosed cancer in American men? Describe its histopathology
Prostatic Adenocarcinoma
Prostatic ducts lined by atypical (dysplastic) epithelial cells and a diminution in the number of basal cells.
What is Leuprolide Acetate?
A Gonadotropin Release inhibitor (used in prostate cancer treatment- tumor cells are androgen dependent)
What is Malakoplakia?
A rare inflammatory disorder of uknown etiology characterized by the accumulation of macrophages- with abundant eosinophilic cytoplasm containing PAS -positive granules. These macrophages exhibit laminated, basophilic calcospherite stermed Michaelis- Gutmann bodies.. Sofy yellow plaques on the mucosal surface of the bladder is common.
What PMH is associated with MALAKOPLAKIA?
It is often associated with an infection of the urinary tract by E. coli.
It is commonly seen in patients with a PMH of chronic infections, cancer or immunosuppression.
Where does ADENOCARCINOMA OF THE BLADDER originate?
Foci of Cystitis Glandularis or
Intestinal Metaplasia or
Remnants of Urachal Epithelium in the bladder dome.
What is usual etiology of Squamous cell carcinoma of the bladdder?
Develops in foci of squamous metaplasia , usually due to shistosomiasis
What is a Hunner Ulcer?
Mucosal ulceration often seen in middle-aged women who suffer from chronic interstitial cystitis that features transmural (mucosa and muscularis affected) inflammation (increased mast cell number and fibrosis) of the bladder wall.
What are common symptoms of chronic interstitial cystitis/
Long-standing suprapubic pain, frequency, and urgency, with or without hematuria
What does scrotal swelling or enlargement usually indicate?
Abnormalities of testicular, epididymal, or scrotal development
(it is often seen in children but it can be seen in adults)
What is a spermatocele?
a cyst formed from the protrusions of the widened efferent ducts of the rete testis or epididymis. It manifests as a hilar paratesticular nodule or as a fluctuating mass filled with milky fluid containing spermatozoa in variety of stages of degeneration
Where does Embryonal Carcinomas invade?
The testis, epididymis, blood vessels
Then metastasizes to abdominal lymph nodes, lungs, and other organs.
