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Flashcards in Pathology - Handorf 2 Deck (38):
1

Ureters

-muscular tubes
25-30cm long, 5-10mm diameter
-leading from renal pelvis to urinary bladder
1. mucosa
2. muscularis
3. adventitia
-not passive, peristaltic contraction of muscle layer propels the urine

2

Obstructive Lesions of Ureter: Intrinsic

-calculi (stones)
-strictures
-neoplasms
-blood clots
-neurogenic causes
-vesicoureteral reflux

3

Obstructive Lesions of Ureter: Extrinsic

-pregnancy
-periureteral inflammation
-sclerosing retroperitoneal fibrosis
-endometriosis
-neoplasms

4

Can pregnancy cause partial obstruction of the ureter?

yes

5

Hydronephrosis

-obstruction of ureter, results in obstruction is interruption of normal outflow of urine from renal pelvis which creates distention of pelvis and increased pressure on parenchyma of kidney
-results in hydronephrosis and possibly pyelonephritis

6

Periureteral Inflammation

-salpingitis
-diverticulitis
-peritonitis
-sclerosing retroperitoneal fibrosis

7

Salpingitis

-inflammation of fallopian tube

8

Diverticulitis

-inflammation of intestinal diverticulum and surrounding ttissues

9

Peritonitis

inflammation of peritoneum

10

sclerosing retroperitoneal fibrosis

-fibrous proliferative inflammatory process encasing retroperitoneal structures including ureter & causing compressing of ureter
-rare,middle-late age
-70% no obvious cause (drugs, Crohn's disease, malignant disease)

11

Cells of Urinary Bladder

-basal cell
-intermediate cell
-umbrella cell
-basement membrane
-subepithelial connective tissue (lamina propria)

12

Endometriosis

-presence of endometrial tissue (ectopic) outside of uterus
-found on surface of organs adjacent to uterus, fallopian tubes, ovaries; sometimes adj to ureters, urinary bladder or intestines
-tissue is functionally active, responds to stimulation by hormones
-proliferation followed by bleeding & scarring can cause ureter compression

13

Ureteritis Cystica

-may dev. as component of urinary tract infections
-sig. morphologic changes arise in longstanding ureteritis
-assumulation of lymphocytes in subepithelial region of ureter in chronic ureteritis may produce fine granularity of mucosa (ureteritis follicularis)
-cystica in which mucosa of ureter shows fine cysts (1-5mm) filled with clear yellow fluid

14

Congenital Anomalies of Ureters: Double

-usually accompanied by partial or complete duplication of renal pelvis

15

Congenital Anomalies of Ureters: Ureteropelvic Junction Obstruction

-usually present in infants/children, boys>girls, more on left
-abnormal organization of excess stromal depositison of collagen b/w smooth muscle bundles
-causes hydronephrosis

16

Congenital Anomalies of Ureters: Diverticula

-saccular outpouchings of ureteral wall (uncommon)
-appear as congenital/acquired (due to increased pressure secondary to obstruction of urine flow) important as pockets of stasis and secondary infection

17

Congenital Anomalies of Ureters

2-3% of all autopsies

18

Urinary Bladder: Congenital & Acquired Anomalies

-obstruction to the bladder neck
-diverticula
-exstrophy
-urachus
-cystocele
-vesicoureteral reflux

19

Urinary Bladder Anomalies Causes

-enlarged prostate
-cystocele of bladder
-post inflammatory fibrosis & contraction of bladder after varying types of cystitis
-bladder tumors
-sec. invasion of bladder neck by growths arising in perivesicule structures (cervix, vagina, prostate, rectum)
-mechanical obs. caused by calculi
-injury to innervation of bladder causing neurogenic or cord bladder

20

Diverticuli

-pouch-like evaginations of bladder wall
-sites of urinary stasis, with potential for infection

21

Congential Diverticuli

-caused by focal muscular defect

22

Acquired Diverticuli

-more common
-arise following persistent urethral obstruction

23

Exstrophy

-developmental defect of closure of anterior wall of the abdomen and the bladder so the bladder communicates with the exterior of the body through a large defect or open sac
-often associated with other abnormalities of GU tract
-increased incidence of malignancy (adenocarcinoma)

24

Urachus

-5-6cm vestigial structure located b/w apex of bladder and umbilicus

25

Cystocele

-protrusion of bladder into the vagina, creating a pouch
-caused by relaxation of pelvic support in females, leading to uterine prolapse (pulls bladder floor downward)
-frequently turn into bladder adenocarcinomas

26

Inflammations of Urinary Bladder

-acute/chronic cystitis
-special forms of cystitis
interstital cystitis (Hunner Ulcer)
malakoplaki
cystitis glandularis
cystitis cystica

27

Malakoplaki

-soft, yellow 3-4cm mucosal plaques composed of closely packed, large, foamy macrophages with occasional giant cells and interspersed lymphocytes
-macrophages contain PAS+ granules filled with bacterial debris
-Michaelis-Gutmann bodes: laminated mineralized concretions within and b/w macrophages
-most likely represents a defective host response to bacterial infections, usually from gram - bacilli

28

Bladder Tumors

-95% in epithelial origin, rest are mesenchymal
-epithelial composed of urothelial (transitional) type

29

Most common to cause Cystitis?

-E coli. >>> then Proteus, Klebsiella, Enterobacter, TB, candida, cryptococcus, schistosoma, virus, chlamydia, mycoplasm - cytotoxic drugs, radiation, trauma

30

Cystitis Glandularis

-cysts are 0.1-1cm, filled with clear fluid, lined by cuboidal or urothelial cells
-MAY predispose to adenocarcinoma of bladder

31

Interstitial Cystitis

Hunner Ulcer
-Persistent, Chronic Cystitis
-most frequent in middle aged women
feamale>male 10:1
-intermittent, severe suprapubic pain, urinary frequency, urgency, hematuria, dysuria without bacterial infection

32

Majority of Bladder Cancers

-high-grade
-most arise from the lateral or posterior walls at the bladder base, partial or complete ureteral obstruction commonly occures
-most >50, male to female 3:1

33

Squamous Carcinoma of the Bladder

-nonsmoker, Egyptian, Nile River Delta

34

Adenocarcinoma of Bladder

-rare (2% of primary bladder cancer)
-develops in setting of cystitis glandularis, exstrophy or in urachal remnant
-unlike TCC, solitary lesion
-generally deeply invasive
-like colon cancer (therapy?)
-poor prognosis

35

Non-gonococcal Urethritis

-E. coli, chlamydia, mycoplasm

36

Urethral Caruncle

tumor
-inflammatory lesion presenting as small, red, painful, friable mass about the external urethral meatus in female patient
-at any age, more common in later life
Histologically: highly vascular, young, fibroblastic connective tissue heavily infiltrated with leukocytes

37

Papillomas

tumor
-occur usually on the external meatus
-viral origin, similar to those affecting the vulva

38

Carcinoma of the urethra

tumor
-rare
-advanced age, women
-arises in external meatus or immediately surrounding structures, most of these are squamous cell carcinomas
-more aggressive than bladder cancers