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Flashcards in Pathology of the Bladder Deck (39)
1

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

2

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.

3

Can diverticula of the ureters occur?

- YES and may cause stasis and secondary infections.

4

What is ureteritis FOLLICULARIS?

- accumulation of LYMPHOCYTES forming germinal centers, causing elevation of mucosa resulting in a fine granularity.

5

What is ureteritis CYSTICA?

- mucosa of ureters sprinkled with fine CYSTS lined by flattened urothelium (transitional cells).

6

Are tumors of the ureters common?

NO, they are very rare.
*fibroepithelial polyp is the one that would form, if it does.

7

What could obstruct the lumen of the ureter (INTRINSIC)?

- calculi
- strictures
- tumors
- blood clots
- neurogenic causes

8

What could cause obstruction of the ureter from the outside (EXTRINSIC)?

- pregnancy
- periureteral inflammation
- endometriosis
- tumors

9

What can result from ureter obstruction?

- hydroureter
- hydronephrosis
- pyelonephritis

10

*** What is sclerosing retroperitoneal fibrosis?

- fibrous proliferative inflammtory process encasing retroperitoneal structures, causing hydronephrosis.

11

What inflammatory conditions can contribute to sclerosing retroperitoneal fibrosis?

- vasculitis
- diverticulitis
- Crohn's disease

12

*** 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.

13

*** 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.

14

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.

15

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

16

What does sterile pyuria (pyuria with negative urine culture) suggest?

- URETHRITIS due to Chlamydia trachomatis or Neisseria gonorrhoeae.

17

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

18

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.

19

What is polypoid cystitis?

- irritation of the bladder mucosa causing polypoid lesions.
- often due to indwelling catheters.

20

What is cystitis glandularis/cystitis cystica?

- nests of transitional epithelium that eventually transforms to cuboidal or columnar epithelium.

21

*** 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.

22

What metaplasia can occur in the bladder?

- squamous metaplasia= converts in response to injury.
- nephrogenic metaplasia= resembles cuboidal epithelium of renal cancers.

23

What are the types of bladder tumors?

- urothelial (transitional cell)= MOST
- squamous cell
- adenocarcinoma
-mesenchymal

24

** 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.

25

What are papillomas of the bladder?

- fibrovascular tissue covered with benign epithelium.
- seen in younger age group

26

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.

27

What is LOW grade papillary urothelial carcinoma?

- one step up from PUNLMPs.
- nuclear atypia and mild pleomorphism (variation in size and shape).

28

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

29

What is carcinoma in situ of the bladder?

- malignant cells in a FLAT urothelium.
- NO invasion into the lamina propria.
- no intraluminal mass.

30

*** 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).

31

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

32

What is the classic presentation of UROTHELIAL (transitional cell) carcinoma?

- painless hematuria in older adults.

33

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").

34

*** 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).

35

What are the risk factors for SQUAMOUS CELL carcinoma of the bladder?

- chronic cystitis
- SCHISTOSOMA hematobium (in MIDDLE EASTERN/EGYPTIAN MALE)
- long-standing nephrolithiasis

36

*** 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.

37

*** Where would you find ADENOCARCINOMA due to urachal remnant? (HIGH-YIELD)

- at the DOME of the bladder

38

*** 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).

39

What are mesenchymal tumors of the bladder?

- rare, but most common is leiomyoma.
*most common in infancy and childhood is embryonal rhadomyosarcoma.