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Lower Urinary Tract Flashcards

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1
Q

how many layers of cells are in contract and dilated states of urinary bladder?

A

Contacted = 5-7 layers
Dilated = 2-4 layers

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2
Q

What are the 7 types of diseases of lower urinary tract?

A

Congenital and acquired anomalies, Inflammation, Metaplastic lesions, Urethral obstructive lesions, urethral caruncle, fibroepithelial polyp, & neoplasms

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3
Q

What are the 8 congenital and acquired lower urinary tract diseases?

A

Ureteropelvic junction obstruction
Ureteral diverticulum
Congenital bladder diverticulum
Acquired bladder diverticulum
Acquired urethral diverticulum
Bladder exstrophy
Vesico-ureteral junction reflex
Urachal anomalies

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4
Q

what is the most common cause of hydronephrosis in children & infants?

A

ureteropelvic junction obstruction

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5
Q

What is the cause of Ureteropelvic Junction Obstruction?

A

abnormal organization of smooth muscle bundles or excess stromal deposition of collagen at the UPJ

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6
Q

In congenital and adult cases, what is the usual presentation of UPJ?

A

congenital = bilateral; common in males
Adults = unilateral; common in females

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7
Q

What congenital disease of the lower urinary tract has a saccular outpouchings along the ureter wall where it gives rise to recurrent infections?

A

Ureteral diverticulum

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8
Q

What congenital disease of the LUT has saccular outpouchings due to focal weakness in the wall?

A

Congenital bladder diverticulum

failure in devt of bladder wall during fetal devt

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9
Q

What congenital disease of the LUT has saccular outpuching of the bladder wall due to INC intravesicular pressure 2ndary to obstruction of urine outflow?

A

Acquired bladder diverticulum

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10
Q

What is the gross finding in acquired bladder diverticulum?

A

thickening or hypertrophy of bladder wall

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11
Q

What are the clinical significance of seeing acquired bladder diverticulum?

A

could indicate:
Urine stasis, Infection, Stone formation, & Increased risk of developing carcinoma

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12
Q

What kind of congenital LUT disease has a pouch that forms along the urethra where it can be filled with urine & lead to infections?

A

Acquired urethral diverticulum

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13
Q

What are the clinical manifestations of acquired urethral diverticulum? Possible cause of this disease?

A

painful vaginal mass
cause –> repeated infections in a periurethral gland that results in blockage –> blocked gland bursts into the urethra

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14
Q

What kind of congenital LUT disease has failure of both abdominal wall and bladder wall to CLOSE during fetal devt?

A

Bladder exstrophy

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15
Q

How does Bladder Exstrophy present?

A

Protrusion of the bladder wall through the lower abdominal wall

Direct communication betw bladder & abdominal surface (exposed bladder)

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16
Q

What could Extrosphy indicate?

A

Adenocarcinoma in the bladder remnant

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17
Q

What kind of lower UT is the most common and serious congenital anomaly and is caused by a congenital abnormality at the UTEROVESCIAL JUNCTION

A

Vesico-Ureteral Junction Reflux

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18
Q

What happens to the bladder during Vesico-Ureteral Junction reflux?

A

Urine flows back to the kidneys (Faulty malfuncitoning valve)

causes UTI, ascending pyelonephritis, & Hydronephrosis

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19
Q

What structure connects the fetal bladder with the allantois?

A

Urachal canal

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20
Q

What congenital LUT disease has incomplete obliteration of the urachus?

A

Urachal anomalies

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21
Q

What are the 4 types of congenital anomalies?

A

Patent urachus
Umbilical-urachal sinus
Vesicourachal diverticulum
Urachal cyst

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22
Q

What is the most common urachal abnormality where there is a communication formed betw THE BLADDER & UMBILICUS as a fistulous urinary tract? What happens bcos of this?

A

Patent urachus
-> Total failure to involute

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23
Q

What kind of urachal abnormality has urachus open into the umbilicus and drainage from the umbilicus causing partial involution?

A

Umbilicus-urachal sinus

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24
Q

What kind of urachal abnormality has wide patent opening into the bladder partial involution?

A

Vesicoureachal diverticulum

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25
What kind of urachal abnormality has urachal cyst formed with urothelial/metaplastic glandular epithelium formed?
Urachal cyst --> can become adenocarcinoma
26
What are the diff inflammatory conditions of LUT?
Acute & Chronic Cystitis Other forms of Cystitis: Polypoid cystitis, hemorrhagic cystitis Special types of cystitis: Malakoplakia of the urinary bladder, Interstitial cystitis Urethritis
27
What is the route of infection in acute & chronic cystitis?
Ascending route
28
What are the predisposing factors for cystitis?
Bladder calculi Urinary obstruction DM Instrumentation Immune deficiency
29
What are the triad of symptoms of cystitis?
Urinary frequency (INC) Lower abdominal pain Dysuria
30
What are the 2 special forms of cystitis?
Eosinophilic cystitis Follicular cystitis
31
What condition is follicular cystitis associated with?
long-standing infection lymhoid follicles in lamina propria are affected
32
what are other forms of cystitis? what makes them be categorized as 'other'?
these are from Iatrogenic causes (radiation cystitis, hemorrhagic cystitis from chemo, & polypoid cystitis) Polypoid cystitis Hemorrhagic cystitis
33
What is the cause of Polypoid cystitis?
irritation of bladder mucosa reulting to instrumentation including indwelling catheters
34
What is the histological feature of Polypoid cysittis?
Urothelium = broad bulbous polypoid projections as a result of marked submucosal edema MAY BE MISTAKEN FOR PAPILLARY UROTHELIAL CARICNOMA
35
What other types of cystitis is associated with the cytotoxic SE of antitumor therapy?
Hemorrhagic cystitis
36
What drug can induce hemorrhagic cystitis?
Cyclophosphamide --> excretes Acrolein (urotoxic)
37
What are the 2 special types of cystitis?
Malakiplakia of the urinary bladder Interstitial cystitis
38
What special type of cystitis where there is a defect in phagocytic & degradative function of macrophages?
Malakoplakia of the urinary bladder
39
What is the gross pathologic finding of Malakiplakia of the urinary bladder?
Yellow soft plaques on the surface of the urinary bladder
40
What is the histologic pathologic finding of Malakiplakia of the urinary bladder?
Abundant foamy histoicytes & Basophilic laminated targetoid sutrctures like Michaelis Gutmann bodies
41
What are Michaelis-Gutmann bodies?
Laminated targetoid structures formed by CaPO4 deposition on bacteria/their fragments
42
What special type of cystitis is aka chronic pelvic syndrome/Hunner's cystitis due to an unknown cause?
Interstitial cystitis
43
What are the clinical symptoms of Interstitial Cystitis?
Urinary frequency INC Dysuria Hematuria Suprapubic pain --> FIbrosis of the muscular bladder wall
44
What are Hunner's ulcers/Hunner's lesions/Hunner's patches?
not ulcers in the usual sense but are distinctive areas of inflammation in the bladder wall that characterize the "classic" form of interstitial cystitis
45
What is the histology of Interstitial cystitis?
Non specific edema, congestion, and nonspecific inflammatory infiltrates dx is only made after other causes have been rules out (repeat urine c/s are all neg for bacte, fungi and viruses)
46
What is a condition often accompanied by cystitis in women & prostitis in men?
Urethritis
47
What are the 2 LUT metaplastic lesions?
Cystitis Glandularis Et Cystica Squamous cell metaplasia
48
What are Brunn nests in Cystitis Glandurlaris Et Cystica?
common lesions in the urinary bladder where clusters of urothelium lie under the surface mucosa
49
What lesion in Cystitis Glandularis Et Cystica has this transformation of the centrla epithelium into cuboidal/columnar lining?
Cystitis glandularis
50
What lesion in Cystitis Glandularis Et Cystica has cystic spaces filled with clear fluid lined by flattened urothelium?
Cystitis cystica
51
What metaplastic lesion has pure SCC associated with chronic irritation & infection?
Squamous cell metaplasia
52
What are the 2 types of ureteral obstructive lesions?
Extrinsic & Intrinsic lesions
53
What are the intrinsic lesions of ureteral obstructive lesions?
Calculi Stricture Tumors Blood clots Neurogenic interruption of the neural pathways to the bladder
54
What are the extrinsic lesions of ureteral obstructive lesions?
Pregnancy -> relaxation of SM Periureteral fibrous scarring Sclerosing Retroperitoneal fibrosis Periureteral tumor extension
55
What are the 3 conditions that can arise from intrinsic and extrinsic lesions of the ureter?
Hydrourter Hyronephrosis Pyelonephrosis
56
What are other causes of ureter obstructive lesions?
Unilateral obstruction Bilateral obstruction
57
What LUT disease has fleshy outgrowings in th edistal urethral mucosa that has inflamed granulation & tissue covered by friable mucosa?
Urethral caruncle
58
What are the causes of urethral caruncle?
Distal urethral prolapse Estrogen withdrawal at menopause
59
Where does Urethral caruncle originate from?
Posterior lip of the urethra
60
What tumor-like lesion in the LUT occurs in children and is composed of loose vascularized CT overlaid by urothelium?
Fibroepithelial polyp
61
Where can urothelial tumors arise?
Pelvis, ureter, bladder, and distal urethra (anywhere w/ ureothelium)
62
What are the risk factors of urothelial cancer?
Cigarette smoking Occupational exposure Irradiation Chronic abuse of peracetic containing analgesics Chronic cystitis caused by S. haematobium
63
What occupation hazard is found to be a bladder carcinogen?
Aromatic amines
64
What genes play a part in the formation of urothelial tumors?
Inactivation of TP53 & RB tumor suppressor genes
65
What are the urothelial tumor preursor lesions?
Non-invasive papillary tumor -> most common Flat non-invasive carcinoma - aka Carcinoma in situ
66
What is the diff betw benign urothelium & carcinoma in situ?
CISU = UMBRELLA CELL LAYER is generally lost BU = lack of marked atypia of basal & intermediate cells
67
What are the 4 morphologic patterns of Urothelial lesions?
papillary urothelial neoplasm, non-invasive Invasive papillary carcinoma Flat non-invasive carcinoma Flat invasive carcinoma
68
Are px whi have had papillary tumors of the urinary bladder at risk of developing invasive carcinoma?
yes, these morphological patterns depend on how it grows
69
What is the morphological pattern of urothelial lesion that grows SLENDER, FINGER-LIKE projections towards the centers of the bladdeR?
Papillary urothelial neoplasm, non-invasive
70
What is the morphological pattern of urothelial lesion that frequently multiplies & the most common form of urothelial lesion?
Invasive papillary carcinoma
71
What is the morphological pattern of urothelial lesion that grows flat and there's a precursor lesion & invasion in the lamina propria and muscularis (THICK)?
flat invasive carcinoma non-invasive if di aabot ng lamina propria & muscularis
72
What are the 3 important gross features of urothelial lesions?
Flat lesions Papillary tumors Papillary Exophytic cauliflower-like large tumors
73
What urothelial lesion is classified as carcinoma in situ?
flat lesions
74
What urothelial lesion is seen as a small exophytic tumor that project into the lumen as wart-like papillary outgrowths?
Papillary tumors
75
What urothelial lesion is seen as an exophytic cauliflower-like large tumors?
Papillary exophytic cauliflower-like large tumors
76
What is the classification of non-invasive papillary urothelial tumors?
1. Papilloma 2. Papillary Urothelial Neoplasm of Low Malignant Potential 3. Non-invasive low grade papillary 4. Non-invasive high grade papillary
77
What is a type of Urothelial neoplasm that has a thicker urothelium w/ INC density of cells?
Punlump
78
What is the diff betw non-invasive LOW & HIGH grade papillary urothelial carcinoma?
LOW - urothelial lining displays MINIMAL cytologic atypia, irrespective of thickness HIGH = marked cytologic and architectural atypia -> highest risk of muscle invasion
79
What are the 4 non-invasive papillary urothelial tumors? From these 4, what are those at risk of muscl e invasion?
Urothelial Papilloma Punlump Non-invasive LOW grade papillary urothelial carcinoma = MODERATE risk of muscle invasion Non-invasive HIGH grade papillary urothelial carcinoma = HIGHEST GRADE of muscle invasion
80
What is an invasive urothelial carcinoma?
it has penetrated the basement mebrane, invaded lamina propria/deeper into the muscularis propria Grade & Depth of invasion = best determinants of prognosis
81
What is the gross feature of Invasive urothelial carcinoma?
Subtle bladder wall thickening to obvious exophytic mass
82
What is the histologic feature of invasive urothelial carcinoma?
high grade nuclear and architectural atypia invasion of the lamina propria and muscularis propria frequent mitosis
83
What are the clinical features of urothelial tumors?
Painless gross hematuria
84
How do we stage bladder cancer using TNM?
Ta = non-invasive papillary Tis = carcinoma in-situ, flat T1 = lamina propria T2 = Muscularis propria T3a = microscopic extension beyond the UB wall T3b = gross extension beyond the UB wall T4 = invades adjacent structures

Pathology (8 decks)

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