Flashcards in Pathology of the Bladder Deck (39)
What is important to know about double and bifid ureters?
- may be associated with distinct double renal pelvises.
- may be associated with anomalous development of a large kidney having a partially bifid pelvis terminating in separate ureters.
- double ureters may purse separate courses in the bladder wall and drain through a single ureteral orifice.
*not usually a problem
What does a ureteropelvic junction obstruction cause?
- HYDRONEPHROSIS usually in infants and children (usually boys).
- will see abnormal organization of smooth muscle bundles with excess collagen.
Can diverticula of the ureters occur?
- YES and may cause stasis and secondary infections.
What is ureteritis FOLLICULARIS?
- accumulation of LYMPHOCYTES forming germinal centers, causing elevation of mucosa resulting in a fine granularity.
What is ureteritis CYSTICA?
- mucosa of ureters sprinkled with fine CYSTS lined by flattened urothelium (transitional cells).
Are tumors of the ureters common?
NO, they are very rare.
*fibroepithelial polyp is the one that would form, if it does.
What could obstruct the lumen of the ureter (INTRINSIC)?
- blood clots
- neurogenic causes
What could cause obstruction of the ureter from the outside (EXTRINSIC)?
- periureteral inflammation
What can result from ureter obstruction?
*** What is sclerosing retroperitoneal fibrosis?
- fibrous proliferative inflammtory process encasing retroperitoneal structures, causing hydronephrosis.
What inflammatory conditions can contribute to sclerosing retroperitoneal fibrosis?
- Crohn's disease
*** What congenital anomalies can occur in the bladder?
- diverticula= pouch-like projections of the bladder wall. Can be acquired also.
- exstrophy= bladder communicates through a defect in the abdominal wall (aka bladder is outside the abdomen). Surgically correctable, but increased risk of developing ADENOCARCINOMA.
*** What is cystitis?
- infection of the bladder that presents as dysuria, urinary frequency, urgency, and suprapubic pain.
- may have hemorrhage and hyperemia of bladder.
*systemic signs (fever) are usually absent.
What are the lab findings for cystitis?
- uninalysis= cloudy urine with greater than 10 WBCs/hpf.
- dipstick= positive leukocyte esterase (due to pyuria) and nitrities (bacteria convert nitrATES to nitrITES).
- culture= greater than 100k colony forming units.
What are the etiologies of cystitis?
- E. coli (80%)
- Staph saprophyticus (young sexually active women)
- Klebsiella pneumoniae
- Proteus mirabilis (ALKALINE urine with ammonia scent)
- Enterococcus faecalis
What does sterile pyuria (pyuria with negative urine culture) suggest?
- URETHRITIS due to Chlamydia trachomatis or Neisseria gonorrhoeae.
What is interstitial cystitis (Hunner ulcer)?
- inflammation and fibrosis of all layers of the bladder.
- characterized by fissures, hemmorrhages, and ulcers.
- usually in women
- sometimes associated with SLE
Can radiation cause cystitis?
- YES, may mimic squamous cell carcinoma, so make sure you tell the pathologist they had radiation.
*can develop decades after radiation exposure.
What is polypoid cystitis?
- irritation of the bladder mucosa causing polypoid lesions.
- often due to indwelling catheters.
What is cystitis glandularis/cystitis cystica?
- nests of transitional epithelium that eventually transforms to cuboidal or columnar epithelium.
*** What is Malakoplakia?
- soft yellow raised mucosal plaques with large foamy macrophages, multinucleated giant cells, and lymphocytes due to chronic bacterial infection.
- Michaelis-Gutmann bodies= laminated mineralized concretions in macrophages and between cells.
- may be seen in immunosuppressed transplant patients.
What metaplasia can occur in the bladder?
- squamous metaplasia= converts in response to injury.
- nephrogenic metaplasia= resembles cuboidal epithelium of renal cancers.
What are the types of bladder tumors?
- urothelial (transitional cell)= MOST
- squamous cell
** What are the 2 precursor lesions leading to bladder cancer?
1. noninvasive papillary tumors
2. carcinoma in situ (not invasive)
* often invasive cancer is NOT associated with a precursor lesion.
What are papillomas of the bladder?
- fibrovascular tissue covered with benign epithelium.
- seen in younger age group
What are PUNLMPs?
- Papillary Urothelial Neoplasms of Low Malignant Potential= similar to papillomas but have increased cellular proliferation.
*rarely metastasize, but should remove these anyway.
What is LOW grade papillary urothelial carcinoma?
- one step up from PUNLMPs.
- nuclear atypia and mild pleomorphism (variation in size and shape).
What is HIGH grade papillary urothelial carcinoma?
- large hyperchromatic nuclei
- frank anaplasia (lack of growth; aka growing backwards).
- loss of polarity
- higher risk of invasion
- greater metastatic potential
What is carcinoma in situ of the bladder?
- malignant cells in a FLAT urothelium.
- NO invasion into the lamina propria.
- no intraluminal mass.
*** What is UROTHELIAL (transitional cell) carcinoma?
- malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra.
*MOST COMMON type of lower urinary tract cancer (usually arises in bladder).
What are some major risk factors for UROTHELIAL (transitional cell) carcinoma?
- cigarette smoke
- naphthylamine (found in cigarettes)
- azo dyes (used for coloring in hair dressers)
- long-term cyclophosphamide or phenacetin use
What is the classic presentation of UROTHELIAL (transitional cell) carcinoma?
- painless hematuria in older adults.
What are the 2 pathways by which UROTHELIAL carcinoma can arise?
1. FLAT= develops as a HIGH-grade flat tumor and then invades (associated with p53 mutations).
- PAPILLARY= develops as a LOW-grade papillary tumor that progresses to a high-grade papillary tumor and then invades.
*tumors are often MULTIFOCAL and RECUR ("field defect").
*** What is SQUAMOUS CELL carcinoma of the bladder?
- malignant proliferation of squamous cells that arise in a background of squamous metaplasia (duh bc there isn't normally squamous epithelium in the bladder).
What are the risk factors for SQUAMOUS CELL carcinoma of the bladder?
- chronic cystitis
- SCHISTOSOMA hematobium (in MIDDLE EASTERN/EGYPTIAN MALE)
- long-standing nephrolithiasis
*** What is ADENOCARCINOMA of the bladder?
- malignant proliferation of GLANDS arising from urachal remnant (urachus was the duct that connected the fetal bladder to the yolk sac), cystitis glandularis (columnar metaplasia from chronic inflammation), or EXSTROPHY.
*** Where would you find ADENOCARCINOMA due to urachal remnant? (HIGH-YIELD)
- at the DOME of the bladder
*** What will you see with Schistosoma haematobium causing SQUAMOUS CELL carcinoma of the bladder?
- terminal spine of parasite (spread by the snail host through water).