Urinary Bladder Flashcards
Lining of cystitis glandularis
Intestinal type epithelium or glandular metaplasia
Type of cystitis with formation of lymhpoid follicles with germinal
Centers
Follicular cystitis
Cystitis associated with indwelling catheters
Papillary or polypoid cystitis
- edematous with broad FV cores
> 6 weeks cystitis with no identifiable cause and development of Hunner ulcers in late stages
Interstitial cystitis
Type of cystitis associated with precipitation of salts with calcified debris embedded in the mucosa
Encrusted cystitis
Pneumatosis of the bladder due to trauma, fistula, instrumentation or urinary stasis. Histologically with air bubbles surrounded by FBGCs
Emphysematous cystitis
Yellowish submucosal plaques mimicking bladder cancer
Amyloidosis
A man with recurrent UTI had a buopsy which showed sheets of foamy macrophages, chronic inflammation, and black intracytoplasmic inclusions
Dx? Stain? Mc organism?
Malakoplakia
Von kossa stain
Michaelis-gutmann bodies
E. Coli
A patient had repeated AUS dx on urine cytology and thus had frequent instrumentation. A biopsy done shows papillary and tubular lesions lined by hobnail epithelial cells that seem to infiltrate the lamina propria and superficial detrusor muscle. There was no mitosis, necrosis, solid growth or invasion
IHC (+) PAX8, CK7 and AMACR
dx?
Nephrogenic metaplasia/adenoma
- metaplastic change from chronic irritation or exfoliated renal tubular cells get implanted on these sites
- mimics malignancy
A UB papillary tumor with exophytic, thin FV cores lined by normal urothelium (normal thickness)
IHC: (+) CK20 on umbrella cells
Dx? Mutation? Prognosis?
Urothelial papilloma
HRAS, KRAS
BENIGN
A 65 year old smoker came in due to hematuria. A polypoid growth is seen in the bladder which was excised. Microsections show a papillary pattern with FV cores lined by urothelial cells with variably increased thickness with cells with mild cytologic atypia and a single nonbasal mitotic figure.
Dx? Molecular? Prognosis?
Noninvasive papillary urothelial carcinoma, low grade
FGFR3 alterations and TERT promoter mutations
Frequent recurrence (50%)
Rare progression to invasive urothelial carcinoma
A UB papillary tumor with marked cytologic atypia present in 5% of the tumor.
Ihc: (+) CK20 (full thickness
Dx? Mutations? Prognosis?
non-invasive papillary urothelial carcinoma, high-grade
TERT promoter
FGFR3 alterations
P53 mutations
P16 loss
Progression to invasive urothelial carcinoma
A 68 year old man came in due to atypical cells seen un urine cytology. Cystoscopy was done and surgeon saw erythematous mucosal patches which were then biopsied. Microsections show a flat mucosal lining with markedly atypical urothelial cells with disordered architecture.
IHC: (+) ck20 (full thickness), p53 aberrant, increased ki67
Dx? Mutation? Prognosis?
Urothelial carcinoma in situ
TERT, p53, DNA damage repair genes, PI3K and MAPK pathways
Frequent recurrence and progression to Invasive urothelial carcinoma
A man working with benzidine dyes came in due to dysuria and hematuria. Cystoscopy showed bladder thickening which was biopsied. Microsections show sheets and single cels invading the lamina propria
IHC: (+) GATA3, p63, HMWCK, CK7 and CK20, uroplakin
(-) Pax8
Dx? Mutations? Risk factors?
Invasive urothelial carcinoma, conventional type
TERT promoter, tp53
Smoking, radiation, benzidine dyes, opiates, high SES
What are the urothelial CA with divergent differentiation?
Comventional invasive urothelial carcinoma +
Squamous diff
Glandular diff
Trophoblastic diff
Subtype of urothelial CA that is agressive and has frequent LVI and HER2 overexpression?
Micropapillary UC
Subtype of UC composed of nests of BLAND urothelial cells resembling Von Brunn nests but infiltrating. Cytologic atypia appears on deeper nests
Dx? Prognosis?
What if nests are larger and with rounded to circumscribed border
NESTED UC
Aggressive
LARGE NESTED
Subtype of UC with singly infiltrating plasmacytoid cells with or without cytoplasmic lumina or vacuoles
IHC: (+) CD138, p63, GATA3, cytoplasmic P120
(-) e-cadherin
Mutation?
Plasmacytoid UC
CDH1 gene mutation leading to loss of E-cadherin
Other subtypes of UC
tubular and microcystic
Sarcomatoid (+) p63, gata3, hmwck
Lipid rich - with lipoblast like cells
Clear cell/glycogen-rich
Lymhpoepithelioma-like
Giant cell UC
Poorly differentiated
Pure SCCA of urinary bladder
Criteria?
Risk factors?
Should not contain concentional UC
indwelling catheter >10 years, bladder stones, smoking, schistosoma haematobium infection
Adenocarcinoma, NOS of UB
patterns?
Ihc?
Enteric/colonic type, mucinous, signet ring or mixed
(+) CK20, CDX2, nuclear beta catenin
-/+ CK7 and GATA3
A 69 year old male complains of dysuria. A mass was seen on the dome of the bladder. Resection was done including umbilicus. Microsections show enteric adenocarcinoma morphology with central necrosis. Patient has no known other masses on PET CT.
IHC: (+) CK20, CDX2
(-) GATA3
Dx?
Urachal carcinoma
Arises from urachal remnant
A 56 year old female complains of difficulty urinating. Cystoscopy showed a urethral mass. Biopsy showed mixed pattern of solid, papillary, tubulocystic areas lined by hobnail cells with clear to eosinophilic cytoplasm.
Ihc: (+) PAX8
(-) GATA3
Dx? Origin?
Clear cell adenocarcinoma
Mullerian
Microsections of a UB mass shows sheets of small cells with high N:C ratio, crush artifact, necrosis and apoptosis
IHC: (+) synaptophysin, chromo and TTF-1
Dx? Mutation?
Small cell neuroendocrine carcinoma of bladder
Inactivation of RB1 gene
A hypertensive 59 year old woman came in due to micturition triggered headaches. A UB mass was seen and buopsied. Microsections show nested cells with granular cytoplasm separated by FV network and sustentacular cells.
(+) synaptophysin, chromo, s100 and GATA3
(-) CK
DX? mutation?
Paraganglioma
SDH mutation
MC cause of hydronephrosis in indants and children
Ureteropelvic junction (UPJ) obstruction
If early, bilateral in 20%, more in males, and associated with other anomalies
In adults, it is more in women
A 46 year old woman came in due to difficulty urinating. Work up showed obstruction on bilateral ureters. What could possibly be the cause?
Pathogenesis?
Sclerosing retroperitoneal fibrosis (SRF)
- fibrotic proliferative inflammatory process that encases retroperitoneal structures and cause hydronephrosis
Primary or idiopathic (Ormond disease)
IgG4-related disease
MC and serious congenital anomaly of the UB
Vesicoureteral reflux
Developmental failure in the anterior wall of the abdomen and the UB.
Prognosis?
Exstrophy of the bladder
Exposed bladder mucosa—> colonic glandular metaplasia
Prone to infection
Increased risk of adenocarcinoma of the bladder remnant
Result of only a central region of patent urachus. Prognosis?
Urachal cyst
- lined by urothelial or metaplastic glandular epithelium
Increased risk for neoplastic transformation (adenocarcinoma)
Type of cystitis in those who receive systemic chemotherapy or pelvic irradiation
Iatrogenic cystitis
Cytotoxic agent that can cause hemorrhagic cystitis
Cyclophosphamide
Type of cystitis when submucosa is infiltrated by eosinophils
Eosinophilic cystitis
An unpleasant sensation in the UB assoc with UB symptoms of more than 6 weeks in the absence of infection and other identifiable causes.
Should it be biopsied? Why?
Interstitial cystitis (chronic pelvic pain syndrome)
Yes, to rule out carcinoma in situ (CIS) which mimics interstitial cystitis
A late ulcerative phase has chronic mucosal ulcers (Hunner ulcers) —> transmural fibrosis may lead to a contracted bladder
A chronic inflammatory reaction that stems from acquired defects in phagocyte function in the setting of chronic bacterial infection mostly by E. Coli or proteus, mostly in the immunosuppressed. Grossly, it is a soft yellow, slightly raised mucosal plaque. Microscopically the macrophages have abundant granular cytoplasm due to phagolysosomes stuffed with bacterial debris. Calcium deposition in the enlarged lysosomes result in laminated mineralized concretions. What are these called? Dx?
Malakoplakia
Michaelis-gutmann bodies
T or F: extensive and multifocal intestinal metaplasia in cystitis glandularis is a precursor to adenocarcinoma
True
Also true for extensive multifocal keratinizing squamous metaplasia —> dysplasia—> scca
(Must be distinguished from glycogenated squamous epithelium in the trigone region of the bladder in women)
Associated with a worse prognosis in urothelial carcinomas
Invasion of the muscularis propria (detrusor muscle)
- 30% 5 year mortality rate
- indication for radical cystectomy or radiation therapy with neoadjuvant or adjuvant chemotherapy
Assoc mutations in non muscle invasive papillary cancers
Progression to muscle invasive cancer?
Gain of function mutations
Amplification of FGFR3
Activating mutations in RAS and PI3K
Frequently recur but progress to cancer in only 20% of cases
Mutations in CIS
Progression to muscle invasive cancer?
Rb and TP53 mutations
Majority of muscle invasive cancers develop from CIS
Difference in prognosis of exophytic papilloma and inverted papilloma?
Exophytic papillomas has a rare chance of progression.
Inverted papillomas are completely benign.
MC benign mesenchymal tumor in the bladder
Leiomyoma
Mc bladder sarcoma
Leiomyosarcoma
A small red painful mass in the external urerheal meatus in older females which consists of inflamed granulation tissue covered by intact but friable mucosa which may ulcerate and bleed with the slightest trauma
Urethral caruncle
Mc malignant UB tumor in children
Botryoid rhabdomyosarcoma
