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Repro - Pathology > Urinary Tract > Flashcards

Urinary Tract Flashcards

1
Q

What are the layers of cells in a urinary bladder?

A
  1. Subepithelial connective tissue
  2. basement membrane – only visible via EM b/c it’s soo thin
  3. basal cells
  4. intermediate cells
  5. umbrella cells
    * these are from bottom up
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2
Q

what are the layers in an ureter

A
  1. Mucosa - composed of transitional epithelium and lamina propria
  2. Muscularis - has external, intermediate, and internal muscle bundles
  3. Adventitia of CT
    * uses peristaltic contractions
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3
Q

What are acquired strictures of the ureter a result of

A

chronic inflammation or sclerosing retroperitoneal fibrosis

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4
Q

What does obstruction of the ureters give rise to

A

hydroureter, hydronephrosis, and sometimes pyelonephritis

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5
Q

Does the ureter more commonly get primary tumors or it is impacted by metastatic tumors?

A

Mets

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6
Q

What are the 2 MC benign primary tumors of the ureter

A

fibroepithelial polyps and leiomyomas

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7
Q

What is the majority of primary malignant tumors of the ureter

A

transitional cell carcinoma – same type is seen in renal pelvis and urinary bladder

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8
Q

What is hydronephrosis

A

obstruction of ureter causes distention of renal pelvis and increased pressue on the parenchyma of the kidney.

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9
Q

What are examples of periureteral inflammation of

A
  1. salpingitis (inflammation of fallopian tube)
  2. Diverticulitis (inflammation of intestional diverticulum and surrounding tissues)
  3. Peritonitis (inflammation of peritoneum)
  4. Sclerosing retroperitoneal fibrosis
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10
Q

what is sclerosing retroperitoneal fibrosis

A

fibrous proliferative inflammatory process encasing the retroperitoneal structures including ureter and causing compression of it.
- Rare!

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11
Q

What is endometriosis of ureter

A

presence of endometrial tissue in ureter. Functionally active. Proliferation is followed by bleeding and eventually by scarring and can cause compression of ureter

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12
Q

What is ureteritis cystica

A
  • may develop due to UTI
  • accumulation of lymphocytes in subepithelial region of ureter may produce a fine granularity
  • another form is mucose of ureter shows fine cysts filled w/ clear yellow fluid
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13
Q

who is uteropelvic junction obstruction common in

A

on the left side of male infants/kids

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14
Q

What are congential and acquired anomalies of the bladder caused by

A
  1. enlargement of prostate
  2. cystocele of bladder
  3. strictures of urethra
  4. post inflammation fibrous and contraction
  5. bladder tumors
  6. mechanical obstruction
  7. injury to innervation of bladder
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15
Q

What will obstruction to the bladder neck result in

A

increased pressure w/in the bladder cuases hypertrophy of its muscle. Trabeculations forms. time crypts form and may become true acquired diverticula.

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16
Q

What are diverticuli

A

pouch like evaginations of bladder wall

  1. congenital caused by focal muscular defect
  2. acquired caused by persistent urethral obstruction
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17
Q

What is exstrophy

A

development defect of anterior wall of abdomen, bladder communications w/ exterior of body via open sac. Increased incidence of adenocarcinoma

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18
Q

What is urachus

A

vestigial structure b/w apex of bladder and umbilicus

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19
Q

What was the normal function of the urachus

A

connected the bladder to the allantois.

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20
Q

What happens when the urachus is totally patent

A

fisutulous urinary tract forms that connects the bladder w/ the umbilicus. If central region of urachus persists then a urachal cysts can form

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21
Q

What will arise in urachal cysts

A

adenocarcinoma

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22
Q

What is cystocele

A

protrusion of the baldder into the vagina, caused by relaxation of pelvic support in females leading to uterine prolapse pulling the bladder floor downward

23
Q

What is the normal angle that the ureters enter the bladder

A

oblique - allows enclosing bladder musculature to act like a sphincteric valve, blocking the upward reflux of urine

24
Q

What is vesicoureteral reflux

A

a defect in the intravesical portion of the ureter. Ureters enter acutely and backward flow of urine is allowed

25
Q

How does cystitis present clinically

A

frequency, lower ab pain, dysuria, may have fever/chills/general malaise

26
Q

What does acute cystitis exudate contain

A

neutrophils

27
Q

What does chronic cystitis exudate contain

A

lymphocytes, plasma cells, and macrophages

* lymphocytes may form follicles called follicular cystitis

28
Q

What is hemorrhagic cystitis due to

A

radiation and chemo but is most commonly seen w/ bacterial cystitis

29
Q

What is malakoplakia

A

soft yellow mucosal plaques composed of closely packed, large, foamy, macrophages w/ occasional giant cells and interspersed lympocytes.
* usually from gram (-) bacilli

30
Q

what is a good stain for malakoplakia

A

PAS+ granules in macrophages

31
Q

What are Michaelis-Gutmann bodies

A

laminated mineralized concretion w/in and btw macrophages in malakoplakia

32
Q

What is interstitial cystitis

A
  • persistent, chronic — middle aged W

- intermittent, suprapubic pain, urinary frequency, urgency, hematuria, dysuria

33
Q

What does interstitial cystitis look microscopically

A

inflammation and fibrosis of all layers of bladder wall, some pts have localized mucosal ulcers (Hunner ulcers)

34
Q

What is cystitis glandularis

A

cysts filled w/ clear fluid and lined by cubodial or urothelial cells. May predispose to adenocarcinoma

35
Q

What is the most common bladder tumor

A

urothelial tumor – can be papillary or flat, most are multifocal at presentation

36
Q

What will definitely lead to precancerous bladder tumor

A

SMOKING – 100% get urothelial dysplasia

37
Q

What do the papillae have centrally

A

loose fibrovascular tissue covered by transitional epithelium cells

38
Q

What does a transitional cell carcinoma in situ look like microscopically

A

Transition from small basal cells to larger intermediate cells to largest umbrella cells are not seen.
* pleomorphic cells, hyperchromatic nuclei, prominent nucleoli, many mitotic figures

39
Q

T or F. Majority of bladder cancers are high grade lesion

A

True. Can invade adjacent prostate, seminal vesicles, ureters, and retroperitoneum. Higher the grade the higher the chance of recurrence.

40
Q

Where does most bladder cancers arise from

A

lateral or posterior walls at bladder base - obstruction of ureter commonly occurs

41
Q

Who gets bladder cancer

A
  • > 50 yr old men. Smokers
42
Q

How does bladder cancer present clinically

A
  1. painless hematuria

2. frequency, urgency, and dysuria

43
Q

where does bladder cancer metastasize to?

A

regional lymph nodes. Hematogenous spread mainly to liver, lungs, and bone marrow occurs late and only w/ highly anaplastic cells

44
Q

Who is commonly thought to get squamous cell carcinoma of the bladder

A

Egyptians b/c of schistosomiasis. Worse prognosis then TCC. Makes up 5% of primary bladder tumors

45
Q

Adenocarcinoma of bladder

A
  1. rare
  2. solitary lesions
  3. deep invasive
46
Q

What are benign bladder neoplams

A
  1. leiomyoma - MC
  2. Hemangionma
  3. Granular cell tumor
  4. Neurofibroma
    * note all are rare to begin with
47
Q

What are malignant mesenchmyal bladder tumors

A
  1. Rhabdomyosarcoma
    • Embryonal form (sarcoma botryoides) - affects infants and kids. Large grape-like polypoid projections into lumen
  2. Leiomyosarcoma
    • common in adults
    • well circumscribed, may protrude into lumen, may ulcerate
48
Q

Urethritis divisions?

A
  1. gonococcal

2. Non-gonococcal - E. Coli, chlamydia, mycoplasma, etc

49
Q

What is the Reiter syndrome

A

clincal triad of arthritis, conjunctivitis, and urethritis

50
Q

What is a urethral caruncle

A

inflammatory lesions presenting as a small, red, painful, friable mass about the external urethral meatus in the female patient. common in later life.

51
Q

What does a urethral caruncle histologically

A

highly vascularized, young, fibroblastic CT heavily infiltrated w/ leukocytes

52
Q

What is a papilloma urethra tumor

A

usually on external meatus, may be of viral origin

53
Q

carcinoma of urethra

A

rare, occurs in advanced age, often in women. most are squamous cell carcinomas. more aggressive than bladder cancer

Repro - Pathology (5 decks)

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