Urinary Pathology Flashcards
Most common cause of hydronephrosis in children is:
UPJ obstruction
3 points of construction of the ureters
UPJ
Crossing iliac vessels
Entrance of the bladder
Cause of congenital bladder diverticulae:
Cause of acquired bladder diverticulae:
Failure of development of normal musculature or some degree of urinary obstruction in development
Urinary obstruction - prostate hypertrophy (most common)
3 pieces of clinical significance of bladder diverticulae
- Urinary stasis -> increased risk for infection and calculi formation
- Predisposition for VUR if impinging ureters
- Rarely carcinomas may arise
Extrophy occurs when…
Who gets it most?
What can happen as a result?
What is their an increased risk for?
What is the prognosis?
The anterior abdominal wall does not close properly and the bladder protrudes.
M=F, W»B
Colonic glandular metaplasia and is subject to infection.
Adenocarcinoma.
Prognosis is good.
Urachal cysts impose an increased risk for: (2)
What is a patent urachus?
Infection and carcinomas
The suspensory ligament is hollow and a tube reaches the umbilicus.
Triad of SX in cystitis
Other “non-classic” SX
Frequency
Dysuria
Pelvic/abdominal pain
Low-grade fever, turbid urine, some hematuria
Complicated UTIs often occur in patients with: (2)
Anatomic/function abnormalities of the UT
Diseases that hamper the natural UT defenses
Positive - Clinical interpretation of urine culture depends on: (4)
Specimen collection, method and handling
Number of isolates
Organisms involved
Quantity
What are the 2 exceptions to the idea that the presence/quantity of squamous epithelial cells in urine is relevant for treatment?
Pts. on anti-microbial therapy when cultures obtained
Pts. with mycobacterial or other abnormal cystic infections
75-90% of cystitis is caused by what organisms? (4)
E coli*
Proteus
Klebsiella
Enterobacter
10-15% of cystitis is caused by what bacteria?
Staph saprophyticus
Predisposing factors for developing cystitis
Bladder calculi Urinary obstructions/structural abnormalities DM Instrumentation Immune deficiency
Radiation of the bladder can cause:
Acute/chronic irradiation cystitis
Cystitis morphology
Usually non-specific acute inflammation w/ hyperemia of the mucosa with occasional exudate
Patients on which medicines can get hemorrhagic cystitis?
What infection is implicated in hemorrhagic cysts?
Anti-tumor drugs, like cyclophosphamide
Adenovirus
Interstitial cystitis (Hunner ulcer)
SX:
Most common in:
What is in culture?
What cells are found on histology?
Chronic, persistent, painful form of cystitis.
Intermittent subrapubic pain, urinary freq/urgency, hematuria, dysuria.
30-40 y/o women.
Negative cultures
Mast cells
Malacoplakia is noted by a pattern of bladder inflammatory reaction characterized by:
What causes it?
What infection is implicated?
Who gets it most?
3-4 cm in diameter soft, yellow, slightly raised mucosal plaques.
Defective phagosome function related to chronic infection.
E coli
F»M middle-aged, most common in immunocompromised pts.
What is a classic histological finding in malacoplakia?
What do these cause?
What else is found (other cells)?
Michaelis-Gutmann bodies - laminated mineralized concretions in macrophages
Deposition in abnormal, enlarged lysosomes.
Foamy Mo, multinucleated giant cells, intersperesed lymphocytes, in areas forming granulomas
Polypoid cystitis is what kind of condition:
Most common cause:
What can it look like and is often misdiagnosed as?
Inflammatory condition from irritation of the bladder mucosa
Indwelling catheters
Papillary carcinoma
Follicular cystitis
Aggregation of lymphocytes in lymphoid follicles in the mucosa and is associated with chronic infection
Eosinophilic cystitis
Infiltration of eosinophils that represents a nonspecific subacute inflammation, but rarely might be associated with autoimmunity or a parasitic infection or a sequel from radiation/chemo
Non-epithelial tumors of the bladder are all:
Most common of all is:
Other examples include:
Common and benign
Leiomyoma
Lipoma, Fibroma, Neurofibroma
Malignant non-epithelial tumors of the bladder (3)
Rhabdomyosarcoma (childhood)
Leiomyosarcoma (adults)
Lymphomas
Embryonal rhabdomyosarcoma is what kind of tumor?
Has what characteristic on histology?
Who is most likely to get it?
Prevalence:
Malignant mesenchymal tumor
Sarcoma botryoides
Children, avg age 4 y/o, M=F
Rare
Leiomyosarcoma is what kind of tumor?
Who most often gets it?
Prevalence:
What can cause it?
Malignant mesenchymal tumor
Avg age 60 y/o, M>F
Rare
Post-chemo/rads occasionally
Primary malignant lymphoma of the bladder
Who gets it most? What is a common manifestation?
What is it made of?
Prognosis?
Prevalence?
65 y/o, F»M, most with chronic cystitis.
Diffuse large B cell and MALT.
Good prognosis
Very rare
> 90% of bladder cancers are….
5% are….
<5% are….
Urothelial (transition) tumors
SCC
Sarcomas and other mesenchymal tumors
Papillary urothelial neoplasia of low malignant potential (PUNLMP) is a…
Major pathological finding…
Precancerous lesion to urothelial malignancy. 15-20% of papillary tumors.
Thickened epithelium covering papillary projections, with minimal atypia.
Most urothelial neoplasias are:
The other 3 varieties are:
Papilloma-papillary carcinoma
Invasive papillary carcinoma
Flat non-invasive carcinoma (CIS)
Flat invasive carcinoma
Flat lesions are more likely to cause:
Papillary lesions are more likely to cause:
Discomfort
Hematuria
Grade 1, 2 and 3 flat urothelial neoplasia
1 - thickened epithelium
2 - atypical hyperplasia (probably means nothing)
3 - CIS
Who is most likely to get bladder cancers?
Older white men (avg age of 73)
Common genetic factors in urothelial carcinoma (2)
Chr 9 monosomy or deletions
Chr 17p deletions (bad sign)
“Dominant clinical finding and typically the only clinical finding” of urothelial carcinoma is:
Painless hematuria
> 40% there is mets at initial dx
Majority of pts. undergo which 2 procedures for urothelial cancer Tx
Transurethral resection (TUR)
Intravesical therapy
Papillary carcinoma - high grade makes up what percent of papillary tumors?
What is the reoccurence rate?
30%
High rate
Most critical prognostic factor in bladder cancer is:
Stage, meaning the degree of muscle invasion
Low stage (Ta, Tis, T1) bladder cancer survival rate:
90-95% at 5 yrs. High reoccurence post Tx but it does not cause death
High stage (T2-T4) bladder cancer survival rate:
50% at 5 yrs
High grade invasive urothelial carcinoma advanced stage (T3) has what appearance grossly?
Nordular tumor that may fill the bladder lumen
Hemorrhage
Yellow areas representing ulceration and necrosis
What is the best way to monitor reoccurence in pts. with high-grade urothelial neoplasia?
What should not be done in pts. with low grade neoplasia?
Urine cytology
Instrumentation because it might stimulate the neoplasm
