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CPR II Exam #2 > Urinary Pathology > Flashcards

Urinary Pathology Flashcards

1
Q

Most common cause of hydronephrosis in children is:

A

UPJ obstruction

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2
Q

3 points of construction of the ureters

A

UPJ
Crossing iliac vessels
Entrance of the bladder

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3
Q

Cause of congenital bladder diverticulae:

Cause of acquired bladder diverticulae:

A

Failure of development of normal musculature or some degree of urinary obstruction in development

Urinary obstruction - prostate hypertrophy (most common)

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4
Q

3 pieces of clinical significance of bladder diverticulae

A
  1. Urinary stasis -> increased risk for infection and calculi formation
  2. Predisposition for VUR if impinging ureters
  3. Rarely carcinomas may arise
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5
Q

Extrophy occurs when…

Who gets it most?

What can happen as a result?

What is their an increased risk for?

What is the prognosis?

A

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.

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6
Q

Urachal cysts impose an increased risk for: (2)

What is a patent urachus?

A

Infection and carcinomas

The suspensory ligament is hollow and a tube reaches the umbilicus.

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7
Q

Triad of SX in cystitis

Other “non-classic” SX

A

Frequency
Dysuria
Pelvic/abdominal pain

Low-grade fever, turbid urine, some hematuria

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8
Q

Complicated UTIs often occur in patients with: (2)

A

Anatomic/function abnormalities of the UT

Diseases that hamper the natural UT defenses

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9
Q

Positive - Clinical interpretation of urine culture depends on: (4)

A

Specimen collection, method and handling

Number of isolates

Organisms involved

Quantity

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10
Q

What are the 2 exceptions to the idea that the presence/quantity of squamous epithelial cells in urine is relevant for treatment?

A

Pts. on anti-microbial therapy when cultures obtained

Pts. with mycobacterial or other abnormal cystic infections

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11
Q

75-90% of cystitis is caused by what organisms? (4)

A

E coli*
Proteus
Klebsiella
Enterobacter

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12
Q

10-15% of cystitis is caused by what bacteria?

A

Staph saprophyticus

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13
Q

Predisposing factors for developing cystitis

A 
Bladder calculi
Urinary obstructions/structural abnormalities
DM
Instrumentation
Immune deficiency
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14
Q

Radiation of the bladder can cause:

A

Acute/chronic irradiation cystitis

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15
Q

Cystitis morphology

A

Usually non-specific acute inflammation w/ hyperemia of the mucosa with occasional exudate

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16
Q

Patients on which medicines can get hemorrhagic cystitis?

What infection is implicated in hemorrhagic cysts?

A

Anti-tumor drugs, like cyclophosphamide

Adenovirus

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17
Q

Interstitial cystitis (Hunner ulcer)

SX:

Most common in:

What is in culture?

What cells are found on histology?

A

Chronic, persistent, painful form of cystitis.

Intermittent subrapubic pain, urinary freq/urgency, hematuria, dysuria.

30-40 y/o women.

Negative cultures

Mast cells

18
Q

Malacoplakia is noted by a pattern of bladder inflammatory reaction characterized by:

What causes it?

What infection is implicated?

Who gets it most?

A

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.

19
Q

What is a classic histological finding in malacoplakia?

What do these cause?

What else is found (other cells)?

A

Michaelis-Gutmann bodies - laminated mineralized concretions in macrophages

Deposition in abnormal, enlarged lysosomes.

Foamy Mo, multinucleated giant cells, intersperesed lymphocytes, in areas forming granulomas

20
Q

Polypoid cystitis is what kind of condition:

Most common cause:

What can it look like and is often misdiagnosed as?

A

Inflammatory condition from irritation of the bladder mucosa

Indwelling catheters

Papillary carcinoma

21
Q

Follicular cystitis

A

Aggregation of lymphocytes in lymphoid follicles in the mucosa and is associated with chronic infection

22
Q

Eosinophilic cystitis

A

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

23
Q

Non-epithelial tumors of the bladder are all:

Most common of all is:

Other examples include:

A

Common and benign

Leiomyoma

Lipoma, Fibroma, Neurofibroma

24
Q

Malignant non-epithelial tumors of the bladder (3)

A

Rhabdomyosarcoma (childhood)
Leiomyosarcoma (adults)
Lymphomas

25
Q

Embryonal rhabdomyosarcoma is what kind of tumor?

Has what characteristic on histology?

Who is most likely to get it?

Prevalence:

A

Malignant mesenchymal tumor

Sarcoma botryoides

Children, avg age 4 y/o, M=F

Rare

26
Q

Leiomyosarcoma is what kind of tumor?

Who most often gets it?

Prevalence:

What can cause it?

A

Malignant mesenchymal tumor

Avg age 60 y/o, M>F

Rare

Post-chemo/rads occasionally

27
Q

Primary malignant lymphoma of the bladder

Who gets it most? What is a common manifestation?

What is it made of?

Prognosis?

Prevalence?

A

65 y/o, F»M, most with chronic cystitis.

Diffuse large B cell and MALT.

Good prognosis

Very rare

28
Q

> 90% of bladder cancers are….

5% are….

<5% are….

A

Urothelial (transition) tumors

SCC

Sarcomas and other mesenchymal tumors

29
Q

Papillary urothelial neoplasia of low malignant potential (PUNLMP) is a…

Major pathological finding…

A

Precancerous lesion to urothelial malignancy. 15-20% of papillary tumors.

Thickened epithelium covering papillary projections, with minimal atypia.

30
Q

Most urothelial neoplasias are:

The other 3 varieties are:

A

Papilloma-papillary carcinoma

Invasive papillary carcinoma
Flat non-invasive carcinoma (CIS)
Flat invasive carcinoma

31
Q

Flat lesions are more likely to cause:

Papillary lesions are more likely to cause:

A

Discomfort

Hematuria

32
Q

Grade 1, 2 and 3 flat urothelial neoplasia

A

1 - thickened epithelium

2 - atypical hyperplasia (probably means nothing)

3 - CIS

33
Q

Who is most likely to get bladder cancers?

A

Older white men (avg age of 73)

34
Q

Common genetic factors in urothelial carcinoma (2)

A

Chr 9 monosomy or deletions

Chr 17p deletions (bad sign)

35
Q

“Dominant clinical finding and typically the only clinical finding” of urothelial carcinoma is:

A

Painless hematuria

> 40% there is mets at initial dx

36
Q

Majority of pts. undergo which 2 procedures for urothelial cancer Tx

A

Transurethral resection (TUR)

Intravesical therapy

37
Q

Papillary carcinoma - high grade makes up what percent of papillary tumors?

What is the reoccurence rate?

A

30%

High rate

38
Q

Most critical prognostic factor in bladder cancer is:

A

Stage, meaning the degree of muscle invasion

39
Q

Low stage (Ta, Tis, T1) bladder cancer survival rate:

A

90-95% at 5 yrs. High reoccurence post Tx but it does not cause death

40
Q

High stage (T2-T4) bladder cancer survival rate:

A

50% at 5 yrs

41
Q

High grade invasive urothelial carcinoma advanced stage (T3) has what appearance grossly?

A

Nordular tumor that may fill the bladder lumen

Hemorrhage

Yellow areas representing ulceration and necrosis

42
Q

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?

A

Urine cytology

Instrumentation because it might stimulate the neoplasm

CPR II Exam #2 (20 decks)

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