Lower Urinary Tract and Male Genital System Flashcards Preview

Question 1

1

Ureter Congenital Anomalies

Answer

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

Question 2

2

Benign Ureteral Neoplasms

Answer

mesenchymal.

Question 3

3

Fibroepithelial Polyps

Answer

small intraluminal projections in kids.

Question 4

4

Malignant Ureteral Neoplasms

Answer

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

Question 5

5

Ureteral Obstruction

Answer

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.

Question 6

6

Diverticula

Answer

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.

Question 7

7

Exstrophy

Answer

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.

Question 8

8

Other Ureteral Anomalies

Answer

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.

Question 9

9

Acute and Chronic Cystitis

Answer

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.

Question 10

10

Interstitial Cystitis

Answer

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.

Question 11

11

Malacoplakia

Answer

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.

Question 12

12

Cystitis Glandularis

Answer

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.

Question 13

13

Cystitis Cystica

Answer

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.

Question 14

14

Squamous Metaplasia of Bladder

Answer

in response to injury.

Question 15

15

Nephrogenic Adenoma of Bladder

Answer

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

Question 16

16

Urothelial Tumors

Answer

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.

Question 17

17

Exophytic Papillomas

Answer

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

Question 18

18

Inverted Papillomas

Answer

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

Question 19

19

Papillary Urothelial Neoplasms of Low Malignant Potential

Answer

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

Question 20

20

Low-Grade Papillary Urothelial Carcinomas

Answer

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

Question 21

21

High-Grade Papillary Urothelial Cancers

Answer

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

Question 22

22

Squamous Cell Carcinomas (Bladder)

Answer

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

Question 23

23

Mixed Urothelial Carcinomas

Answer

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

Question 24

24

Bladder Adenocarcinomas

Answer

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

Question 25

25

Mesenchymal Tumors of Bladder

Answer

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

Question 26

26

Urethritis

Answer

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.

Question 27

27

Hypospadia

Answer

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.

Question 28

28

Epispadia

Answer

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.

Question 29

29

Phimosis

Answer

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).

Question 30

30

Penile Inflammation

Answer

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.

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Lower Urinary Tract and Male Genital System Flashcards Preview

Pathology > Lower Urinary Tract and Male Genital System > Flashcards

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.

Benign Ureteral Neoplasms

mesenchymal.

Fibroepithelial Polyps

small intraluminal projections in kids.

Malignant Ureteral Neoplasms

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

Ureteral Obstruction

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.

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.

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.

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.

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.

Malacoplakia

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.

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.

Squamous Metaplasia of Bladder

in response to injury.

Nephrogenic Adenoma of Bladder

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

Urothelial Tumors

Exophytic Papillomas

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

Inverted Papillomas

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

Papillary Urothelial Neoplasms of Low Malignant Potential

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

Low-Grade Papillary Urothelial Carcinomas

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

High-Grade Papillary Urothelial Cancers

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

Squamous Cell Carcinomas (Bladder)

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

Mixed Urothelial Carcinomas

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

Bladder Adenocarcinomas

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

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

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.

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.

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.

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).

Penile Inflammation

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ureteropelvic junction obstruction = important cause of hydronephrosis in kids.

secondary to disorganized junctional smooth muscle, excess stromal matrix, or compression by renal vessels.

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.

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.

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.

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.

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.

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.

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.

when shed tubular cells implant and proliferate at sites of injured urothelium.

benign although can extend into superficial detrusor muscle.

urothelium over finger-like papillae with loose fibrovascular cores.

low incidence of progression or recurrence.

98% 10 yr survival.

bland urothelium extending into lamina propria.

uniformly benign.

98% 10 yr survival.

orderly cytology and architecture with minimal atypia.

can invade but rarely fatal.

98% 10 yr survival.

transurethral resection.

have discohesive cells with anaplastic features and architectural disarray.

high risk (80%) for rogression and metastases.

25% mortality rate.

associated with chronic bladder infection and inflammation.

3-7% of bladder cancers.

more frequent in countries with endemic schistosomiasis.

with areas of squamous carcinoma are invasive, fungating, and/or ulcerating tumors.

more common than purely squamous cell bladder cancers.

rare.

from urachal remnants or in setting of intestinal metaplasia.

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

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.

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.

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).