Urinary Bladder

Question 1

Ectopia vesica may be associated with……in females &……in males
It is complicated by…….

Answer 1

Split clitoris
Epispadius
UTI, squamous or glandular metaplasia of urothelium & carcinoma (transitional, squamos, adenocarcinoma)

Question 2

Vesical diverticulum arise as a result of…..

Answer 2

Persistant urethral obstruction (e.g. BPH)

Question 3

List predisposing factors to cystitis

Answer 3

1. Bilhariziasis
2. Stasis
3. Inflammation of nearby organs
4. Trauma to UB
5. Congenital anomalies of UB
6. General disease e.g. DM

Question 4

Describe cause & morphology of the following types of cystitis
1. Interstitial
2. Makakoplakia
3. Polypoid
4. Hemorrhagic

Answer 4

1. Persistent painful chronic form of cystitis commonly in females. There is non-specific inflammation extending to muscle layer ending in transmural fibrosis due to defect in GAG layer that protects urothelium from direct contact with urine.
2. Associated with immune deficiency states. Mucosa in region of trigone shows muliple nodular yellow soft thickenings 1-4 cm in diameter. Microscopically, the subepithelial tissue is infiltrated with chronic inflammatory cells with multiple forgein body giant cells containing calcified material known as Michaelis-Gutman bodies which are believed to be end result of bacterial degradation.
3. Polypoid projections of bladder mucosa due to submucosal edema
4. Inflammation with intramural Hge, due to cytotoxic drugs or adenovirus infection

Question 5

Mention risk factors for urothelial malignant neoplasms

Answer 5

1. UB Bilhariziasis due to mechanical irritation resulting in metaplastic changes, repeated bacterial infection associated wih it
2. Aniline dyes
3. Cigarette smoking
4. Chronic irritation by stones &chronic cystitis
5. Leukoplakia
6. Congenital anomalies (ectopia vesica)

Question 6

Mention genetic mutations predisposing to urothelial carcinoma

Answer 6

1. Mutations & activation of Ras oncogene & fibroblast growth factor R-3 (in superficial tumors)
2. Mutations & loss of function of tumor suppressor genes, TP53 & RB genes (in muscle invasive tumors)

Question 7

Precurors of invasive carcinoma is…..&…..

Answer 7

Non-invasive papillary urothelial tumors & carcinoma in situ

Question 8

List grades of non-invasive papillary carcinoma

Answer 8

1. Papilloma: papillae covered by normal looking epithelium
2. Papillary urothelial neoplasm of low malignant potential: papillae covered by thickened urothelium >7 layers with no or minimal atypia
3. Low grade papillary urothelial carcinoma: papillae covered by urothelium with low grade of anaplasia
4. High grade PUC, covered by highly atypical urothelium with frequent mitoses

Question 9

Describe microscopic features of invasive urothelial carcinoma

Answer 9

-High-grade infiltarting papillary or diffuse sheets of malignant transitional epithelial cells invading the lamina propria or muscle layer
-Squamous or glandular differentiation commonly occurs

Question 10

The most important prognositic factor for invasive urothelial tumors is……

Answer 10

Extent of invasion or spread (stage) at the time of initial diagnosis

Question 11

List lines of treatment for urothelial malignant neoplasms

Answer 11

1. Non-invasive or superficially invasive: cytoscopic resection + local ttt (BCG)
2. Cystectomy in cases if muscle invasion, CIS or high grade papillary no responding to BCG, CIS extending to prostatic urethra

Question 12

Adenocarcinoma may arise from……….

Answer 12

Urachal remnants in dome of bladder or areas of cystitis glandularis (after metaplasia)

Question 13

List causes of hematuria

Answer 13

1. Urinary bilhariziasis
2. Inflammatory diseases
3. Renal stones
4. Nodular hyperplasia of prostate
5. Tumors of urinary system
6. Circulatory disturbances
7. Congenital PKD
8. Haemorrhagic blood diseases (e.g. purpura, leukemia, hemophilia)