Lower Urinary Tract and Male Genital System Flashcards Preview

Pathology > Lower Urinary Tract and Male Genital System > Flashcards

Flashcards in Lower Urinary Tract and Male Genital System Deck (70)
Loading flashcards...
1

Ureter Congenital Anomalies

  • ureteropelvic junction obstruction = important cause of hydronephrosis in kids.
    • secondary to disorganized junctional smooth muscle, excess stromal matrix, or compression by renal vessels.

2

Benign Ureteral Neoplasms

  • mesenchymal.

3

Fibroepithelial Polyps

  • small intraluminal projections in kids.

4

Malignant Ureteral Neoplasms

  • urothelial carcinomas, similar to tumors in renal pelvis and bladder.

5

Ureteral Obstruction

  • can be secondary to calculi or clots, strictures, tumors, or neurogenic bladder dysfunction.
  • ureteral dilation less important than secondary renal hydronephrosis or pyelonephritis.
  • sclerosing retroperitoneal fibrosis = uncommon cause of obstruction having retroperitoneal inflammation and fibrosis, encases ureters and leads to hydronephrosis.
    • most have no cause (Ormond disease). can be from: drugs, neoplasms, inflammation.

6

Diverticula

  • outpouchings of bladder wall that arise as congenital defects or are acquired from persistent urethral obstruction (prostatic enlargement).
  • urinary stasis predisposes to infection and calculi formation, also vesicoureteric reflux.
  • if have carcinoma with it, is more advanced from thinned wall.

7

Exstrophy

  • due to development failure of anterior abd wall. bladder communicates directly with overlying skin or lies as exposed sac.
  • complications = chronic infection and ↑ incidence of adenocarcinoma.
  • can be surgically corrected.

8

Other Ureteral Anomalies

  • vesicoureteral reflux, connections btw bladder and vagina, rectum, uterus, or umbilicus.  
    • umbilicus is from remnant fistulous tract of urachus that connected fetal bladder and allantois.
    • urachal cyst when only central portion of tract persists.

9

Acute and Chronic Cystitis

  • UTI.  
  • from bacteria, TB, fungi, viruses, Chlamydia, mycoplasma.
  • schistosomiasis cystitis common in middle east.
  • radiation and chemo can cause inflammation and hemorrhage.
  • presentation: urinary frequency, lower abd pain, and dysuria.

10

Interstitial Cystitis

  • aka chronic pelvic pain syndrome.
  • chronic cystitis in women, causing pain and dysuria without infection.
  • punctate hemorrhages early, then localized ulceration (Hunner ulcer) with inflammation and transmural fibrosis.
  • have mast cells.

11

Malacoplakia

  • in chronic bacterial cystitis (E. coli or Proteus), in immunosuppressed pts.
  • lesions are 3-4cm soft, yellow, mucosal plaques made of foamy macrophages and bacterial debris.
  • macrophages have intra-lysosomal laminated calcified concretions = Michaelis-Gutmann bodies.
  • have defective macrophage phagocytic or degradative function.

12

Cystitis Glandularis

  • can be in normal bladder or with chronic cystitis.
  • composed of Brunn nests (nests of transitional epithelium) that grow downward into lamina propria and transform into cuboidal epithelium.
  • sometimes has intestinal metaplasia.

13

Cystitis Cystica

  • in normal bladder and chronic cystitis.
  • made of Brunn nests (nests of transitional epithelium that grow downward into lamina propria and transform into flattened cells lining fluid-filled cysts.

14

Squamous Metaplasia of Bladder

  • in response to injury.

15

Nephrogenic Adenoma of Bladder

  • when shed tubular cells implant and proliferate at sites of injured urothelium.
  • benign although can extend into superficial detrusor muscle.

16

Urothelial Tumors

  • occur anywhere from renal pelvis to distal urethra.
  • precursor lesions: non-invasive papillary tumors = most common, range of atypia that can reflect biologic behavior.
    • carcinoma in situ = high grade lesion of malignant cells in flat urothelium.  lack cohesiveness and shed into urine.
  • involvement of muscularis propria (detrusor muscle) is major determinant of outcome, 50% 5 yr mortality.
  • pathogenesis: 3:1 M:F.  affects urban populations more.  80% btw ages 50-80 yrs.
    • risk factors: cigarettes, arylamines, schistosoma haematobium infection, chronic analgesic use, long term cyclophosphamide exposure, bladder radiation.
    • 30-60% have chromosome 9 mutations, affects p16 and p15.  p53.
  • morphology: papillary are low grade, red excrescences 0.5-5cm in size.
    • CIS = mucosal reddening, granularity, or thickening without evident intraluminal mass.
      • multifocal.  untreated - 50-75% becomes invasive.
  • presentation: painless hematuria, frequency, urgency, dysuria.  60% single, 70% localized at diagnosis.
    • develop new tumors after excision, are new or shedding/implantation.

17

Exophytic Papillomas

  • urothelium over finger-like papillae with loose fibrovascular cores.
  • low incidence of progression or recurrence.
  • 98% 10 yr survival.

18

Inverted Papillomas

  • bland urothelium extending into lamina propria.
  • uniformly benign.
  • 98% 10 yr survival.

19

Papillary Urothelial Neoplasms of Low Malignant Potential

  • slightly larger than papillomas with thicker urothelium and enlarged nuclei, rare mitoses, infrequent invasion.

20

Low-Grade Papillary Urothelial Carcinomas

  • orderly cytology and architecture with minimal atypia.
  • can invade but rarely fatal.
  • 98% 10 yr survival.
  • transurethral resection.

21

High-Grade Papillary Urothelial Cancers

  • have discohesive cells with anaplastic features and architectural disarray.
  • high risk (80%) for rogression and metastases.
  • 25% mortality rate.

22

Squamous Cell Carcinomas (Bladder)

  • associated with chronic bladder infection and inflammation.
  • 3-7% of bladder cancers.
  • more frequent in countries with endemic schistosomiasis.

23

Mixed Urothelial Carcinomas

  • with areas of squamous carcinoma are invasive, fungating, and/or ulcerating tumors.
  • more common than purely squamous cell bladder cancers.

24

Bladder Adenocarcinomas

  • rare.
  • from urachal remnants or in setting of intestinal metaplasia.

25

Mesenchymal Tumors of Bladder

  • rare.
  • benign = look like elsewhere.  ex: leiomyomas (most common).
  • sarcomas = large (10-15cm), exophytic masses.
    • most common in kids = embryonal rhabdomyosarcoma
    • most common in adults = leiomyosarcoma

26

Urethritis

  • either gonococcal or non-gonococcal.
    • men usually have prostatitis, women usually have cystitis.
    • most common non-gonococcal = E. coli and enterics.
    • Chlamydia = 25-60% NGU in men, 20% in women.
    • mycoplasma is least frequent
  • Reiter syndrome = urethritis, arthritis, conjunctivitis.  associated with NGU.

27

Hypospadia

  • malformations of urethral canal producing aberrant openings on ventral aspect of penis.
  • associated with urogenital malformations (undescended testes).
  • constriction can predispose to UTIs.
  • severe displacement can cause sterility.

28

Epispadia

  • malformation of urethral canal that can produce aberrant openings on dorsal surface of penis.
  • associated with urogenital malformations (undescended testes).
  • constriction predisposes to UTIs.
  • severe displacement can cause sterility.

29

Phimosis

  • prepuce (foreskin) orifice too small to permit normal retraction.
  • usually due to inflammation.
  • predisposes to secondary infections and carcinoma from chronic accumulation of secretions and other debris (smegma).

30

Penile Inflammation

  • involve both glans penis and prepuce.
  • sexually transmitted = syphilis, gonorrhea, chancroid, lymphopathia venereum, herpes, granuloma inguinale.
  • balanoposthitis = non-specific infection by other organisms (Candida, Gardnerella, anaerobic or pyogenic bacteria).
    • from poor local hygiene in uncircumcised males from smegma, can cause phimosis.