Fung: GU Pathology Flashcards by Megan Foggia

What are the three layers of the urinary tract?

urothelium
lamina propria
smooth muscle

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What is the epithelium of the urinary tract called? What is located at the top (superior end) of this layer?

urothelium; umbrella cells

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What are some congenital anomalies of the urinary bladder?

extrophy
diverticula
vesicoureteral reflux

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What bugs can cause acute & chronic cystitis?

E. Coli
Proteus
Klebsiella
Enterobacter

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What is interstitial cystitis? How will it present?

thickening of the bladder wall due to nonspecific inflammation - not due to a bug
will get chronic pelvic pain, hematuria, urgency, frequency of urination
BUT no leukocyte esterase or nitrates, bc no infection

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What is malacoplakia? How does it present?

malacoplakia is caused by a defect in macrophages, which typically gobble up debris - when there is a defect, they become filled with bacteria & present as plaques or nodules that irritate the bladder

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What is polypoid cystitis? How does it differ from papillary cystitis?

formation of polyps due to reactive process as a response to irritation;
papillary will have fibrovascular cords

**both are benign, reactive changes to irritation

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Four metaplastic lesions of the urinary system?

cystitis cystica (et glandularis)
squamous metaplasia
intestinal metaplasia
nephrogenic adenoma

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What is one characteristic feature of cystitis cystica?

Nests of von Brunn - groups of proliferating urinary tract mucosal cells isolated in the urinary tract submucosa.

**urothelium can cystically dilate and take on glandular features

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Malignant proliferation of squamous cells, usu involving the bladder
Arises in a background of squamous metaplasia

squamous cell carcinoma of the bladder

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RIsk factors for squamous cell carcinoma of the bladder?

chronic cystitis
Schistosoma hematobium (in Egypt)
long standing nephrolithiasis

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Malignant proliferation of glands, usu involving the bladder

adenocarcinoma

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Benign adenoma caused by the shedding of renal tubular cells from the kidney that implant in the bladder

nephrogenic adenoma

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Urothelial cell carcinoma can arise in one of two ways - what are they?

flat - develops as a high grade flat tumor & then invades

papillary - develops as a low-grade papillary tumor –> high grade papillary tumor –> invades

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Discuss the 5 grades of urothelial tumors

urothelial papilloma
urothelial neoplasms of low malignant potential
papillary urothelial carcinoma (low grade)
papillary urothelial carcinoma (high grade)
urothelial carcinoma in-situ

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What differentiates a low grade lesion from a high grade lesion in regard to the urothelial cells?

low grade lesion will have thickened layers, and a bit of atypia, but not enough to call it a neoplasm

high grade lesion, cell size and polarity will be different, marked atypia

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What will urothelial carcinoma in situ look like histologically?

malignant cells, which are disadhesive (shed easily), but no invasion yet of the lamina propria

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What happens when a urothelial cell carcinoma becomes invasive?

it invades the lamina propria & the detrusor muscle

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How would you differentiate a squamous cell carcinoma of the bladder from an adenocarcinoma?

squamous - keratin & intercellular bridges - PINK

adenocarcinoma - glandular

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Benign warty growth on genital skin
Due to HPV type 6 or 11
Characterized by koilocytic changes

condyloma

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What will you see in the nuclei of cells of a condyloma?

raisin-like nuclei - koilocytic changes

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Opening of the urethra on the inferior surface of the penis

Due to failure of the urethral folds to close

Hypospadias

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Opening of the urethra of the superior surface of the penis
Due to abnormal positioning of the genital tubercle
Associated w bladder extrophy

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Epispadias

Inflammation of the glans penis, due to poor hygiene, leading to bacteria and fungal build up by candida, anaerobic bacteria, gardnerella, pyogenic bacteria

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balanitis

(blank) can lead to scarring of the foreskin, which can prevent the foreskin from being retracted.

smegma

Smegma can predispose males to (blank) of the penis

squamous cell carcinoma

The testes are made up of (blank), which is the location of spermatogenesis.

semineferous tubules

Describe the pathway of sperm from the semineferous tubules to the urethra

tubules --> rete testes --> ductus efferentes --> epididymis --> ductus deferens

What are the two layers of the testes?

tunica vaginalis on the outside tunica albuginea closer to the testes **space in between is called serous space

What are the cell types within the semineferous tubules? What does each do?

sertoli cells - support, nourish, and protect the spermatids Leydig cells - secrete testosterone, found in the interstitial space

Failure of the testicle to descend into the scrotal sac Normally, the testicles develop in the abdomen and then descend into the scrotal sac as the fetus grows Most cases resolve spontaneously, but nay need orchiopexy Can cause testicular atrophy with infertility

cryptorchidism

Where are spermatids located within the sertoli cells?

Mature spermatids are closer to the lumen of the cell, while spermatogonia in the beginning stages are along the border of the cell

Fluid collection within the tunica vaginalis | Associated with incomplete closure of the processus vaginalis

hydrocele

What will happen when you shine light on a hydrocele?

it will transilluminate

This occurs when the testicle twists on itself and blocks venous drainage Presents as sudden testicular pain and absent cremasteric reflex

testicular torsion

What are the two major types of testicular tumors?

germ cell tumors (95%) | sex-cord stromal tumors (5%)

What are the two main forms of germ cell tumors? What is the difference between the two?

seminomatous vs non-seminomatous seminomatous tumors are highly responsive to chemotherapy, while nonseminomas are not (worse prognosis)

50% of all testicular germ cell tumors Most common testicular tumor Called dysgerminoma in the ovary Malignant tumor comprised of large cells with clear cytoplasm and central nuclei Form a homogenous mass with no hemorrhage or necrosis

seminoma

Malignant tumor of the testes comprised of immature, primitive cells that may produce glands Forms a hemorrhagic mass with necrosis Aggressive, higher grade neoplasm Increased AFP or beta-HcG

embryonal germ cell carcinoma

Most common testicular tumor in kids Schiller-Duval bodies (glomerulus like structures on histology) Produced AFP

yolk sac tumor

Malignant testicular tumor of syncytiotrophoblasts & cytotrophoblasts (placenta like tissue) Produce beta-HcG

choriocarcinoma

Tumor composed of mature fetal tissue derived from two or three embryonic layers Malignant in males

mature teratoma vs immature teratoma (can contain immature neurologic tissue)

This sex-cord stromal tumor produces androgen, causing precocious puberty in kids or gynecomastia in adults

leydig cell tumor

What is the characteristic feature of a leydig cell tumor?

Reinke crystals

This sex-cord stromal tumor is comprised of tubules & it usu clinically silent

sertoli cell tumor

What makes up the prostate?

glands and stroma | glands have inner layer and outer layer of basal cells

What do the glands of the prostate produce?

milky fluid that is added to sperm and seminal vesicle fluid to make semen

Acute inflammation of the prostate Usu due to Chlaydia and Neisseria gonorrhoeae in young adults, or E.Coli and pseudomonas in older adults Presents as dysuria with fever and chills Prostate secretions will have WBCs, cultures will reveal bacteria

acute prostatitis | vs chronic prostatitis, in which cultures would be negative

Hyperplasia of the prostate stroma and glands

BPH

Does BPH increase the risk for cancer? What is it caused by?

no! it is related to production of DHT --> testosterone is converted to DHT in the stromal cells, and DHT acts on the androgen receptors of stromal and epithelial cells resulting in hyperplastic nodules

In what area of the prostate does BPH occur?

in the central zone (periurethral)

Clinical features of BPH?

problems starting & stopping urine impaired bladder emptying dribbling

How to treat BPH?

alpha 1 antagonists - to relax smooth muscle | 5alpha reductase inhibitors, which block conversion of testosterone to DHT, also useful for male pattern baldness

Malignant proliferation of prostate glands The most common cancer in men Usu clinically silent, but may present as low back pain if it spreads to the lumbar spine or pelvis

prostate adenocarcinoma

How do you screen for prostate cancer?

digital rectal exam | PSA (PSA > 10 is worrisome, but Fung says greater than 4 is bad)

If you suspect prostate adenocarcinoma, you should do a prostatic biopsy and this grading system...

Gleason grading system Scoring: From 1-5, look at distribution of glands (look at the two most common presentations, and give them a score of 1-5, then add the score) Ex: 1 = small, uniform glands (well differentiated) 2 = distinct glands but they infiltrate 3 = still distinct gland formation 4 = no distinct gland formation, blending 5 = high grade cells, with necrosis - lack of or occasional glands (poorly differentiated)

Fung: GU Pathology Flashcards

(56 cards)