Pathology 2

Question 1

epithlium in bladder?

Answer 1

lots of folds
transitional epithelium (stratified, looks like squamous)
has ability to thin out when bladder distends
has umbrella cells on surface and 5-6 layers of epithelium beneath

Question 2

what structures are lined by transitional epithelium?

Answer 2

ureters
bladder
most of urethra

Question 3

what is cystitis?

Answer 3

inflammation in the bladder?
3 main groups of causes
- parasites and mycotic infection
- aseptic
- reactive to cathters

Question 4

main parasitic cause of cystitis?

Answer 4

schistosomiasis haematobium
often picked up in water
not actually toxic, its just body’s reaction to it that causes problem
parasite leaves eggs behind that calcify and body continues to react to it

Question 5

where is schistosomiasis commonly found?

Answer 5

lake malawi

Question 6

what can schistosomiasis lead to?

Answer 6

metastatic change from transitional to keratinised squamous epithelium
can eventually lead to squamous cell carcinoma

Question 7

squamous cell carcinoma in the bladder indicates what?

Answer 7

something causing metaplastic change (e.g persistent inflammation)

Question 8

iatrogenic cause of persistent inflammation in the bladder and what does this lead to?

Answer 8

in-dwelling catheter

scarring, metaplasia and eventually squamous cell carcinoma

Question 9

what groups are at higher risk of SCC in the bladder?

Answer 9

paraplaegics

have no sensation in the bladder so don’t know they have inflammation

Question 10

what is aseptic cystitis?

Answer 10

used to be called interstitial cystitis
no causative organism, may be a kind of hypersensitivity reaction
persistent symptoms of UTI (dysuria etc)
persistently negative cultures and urinalysis and no reaction to antibiotics

Question 11

describe pathology of aseptic cystitis on biopsy

Answer 11

some inflammation
congestion
mast cells
- often biopsied as don’t know what’s causing inflammation

Question 12

what is cystitis cystica?

Answer 12

descriptive term of florid inflammation causing infolding of bladder mucosa into cysts
- not really cysts, folding just looks like cysts

Question 13

2 other causes of bladder inflammation?

Answer 13

diverticulae in bladder - stagnant urine, infection, stones and cancer
obstruction - prostatism (bladder muscle works hard and becomes trabeculated (thickened and ridged) eventually causing back pressure)

Question 14

how can obstruction cause a problem?

Answer 14

any obstruction, stone or tumour can cause back pressure (last point in the tract is kidney)
collecting system then becomes dilated and causes hydronephrosis

Question 15

describe hydromephrosis?

Answer 15

kidney is normal size, just full of urine instead of kidney structures

Question 16

how does site of blockage affect damage to kidneys?

Answer 16

if lower down (urethra etc) back pressure will affect both kidneys
if upper in the tract (e.g in one ureter) only 1 kidney affected

Question 17

common bladder cancer?

Answer 17

urothelial neoplasia (type of transitional cell carcinoma)
- occurs in middle aged and elderly (both genders)

Question 18

main risk factors for urothelial neoplasia?

Answer 18

smoking (huge association,

working in the dye industry

Question 19

describe transitional cell carcinoma

Answer 19

often papillary - finger like projection
can also see CIS (carcinoma in situ?) - flat
difference in size of nuclei

Question 20

other types of bladder cancer (less common) and what causes it?

Answer 20

adenocarcinoma
often occurs on a background of metaplasia
- therefore difficult to distinguish from colon cancer which has invaded through
urethrocarcinoma

Question 21

what are the rectum and bladder derived from?

Answer 21

alantois = bladder
rectum = cloaca

Question 22

what is the urachus?

Answer 22

remnant of the alntois
connects between dome of bladder to the umbilicus
usually involutes
can remain patent in some people and adenocarcinoma can develop inside

Question 23

when can squamous cell carcinoma occur in the bladder?

Answer 23

background inflammatory change (metaplasia etc)

Question 24

function of prostate?

Answer 24

secretes prostatic fluid and fluid from seminal vesicles
some contractile function during ejaculation
don’t really need it so can be removed if cancerous

Question 25

normal prostate histology?

Answer 25

bilayered acinar structures
looks frilly
normal to have a little bit of hyperplasia

Question 26

how does prostate change in life?

Answer 26

continues to get bigger with ageing under hormonal influence

affects central and transitional zones which can affect flow of urine

Question 27

where in the prostate does hyperplasia usually affect, what does this mean for management?

Answer 27

centrally (central and transitional)

means transurethral resection is needed (cant just shave a bit off the side)

Question 28

how common is prostate cancer?

Answer 28

at 50 - 30% have it
at 70 - 70%
at 90 - 90%
however most are low grade and slow growing so older people commonly die of something else first and patients often are just followed up

Question 29

risk factors for prostate cancer?

Answer 29

not a clear cause as it so common

cadmium batteries

Question 30

where does prostate cancer often occur on the gland?

Answer 30

periphery

therefore biopsy is done transrectal

Question 31

which is more associated with hormones, BPH or prostate cancer?

Answer 31

BPH

Question 32

how is prostate cancer diagnosed?

Answer 32

PSA (not specific, only shows enlargement)
transrectal biopsy (5-6 in each lobe)

Question 33

why is PSA unreliable?

Answer 33

high grade cancer cells are less like normal prostate epithelial cells
therefore high grade cancers wont produce PSA so ca have normal PSA with high grade cancer

Question 34

what benign things can cause in increase in PSA?

Answer 34

PR exam
BPH
prostitis
spironolactone
riding a bike

Question 35

how can PSA be used post treatment?

Answer 35

to follow up and check for recurrence

Question 36

how is prostate cancer graded?

Answer 36

gleason grading

• combination of 2 numbers, each out of 5
• lowest grade = 6 (3+3)
• highest grade = 10 (5+5)