Renal Pathology Chapter 21 Part 2 Flashcards Preview

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Flashcards in Renal Pathology Chapter 21 Part 2 Deck (74)
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Secondary Tumors of the Bladder

most often by direct extension from primary lesions in nearby organs, cervix, uterus, prostate, and rectum
-lymphomas may involve the bladder as a component of systemic disease, but also, rarely, as primary bladder lymphoma


Most common cause of bladder obstruction in males

-enlargement of the prostate gland due to nodular hyperplasia


Bladder obstruction in females

-less common
-caused by cystocele of the bladder


Infrequent causes of bladder obstruction

-congenital urethral strictures, inflammatory urethral strictures, inflammatory fibrosis and contration fo the bladder, bladder tumors, invasion of the bladder neck by tumors arising in contiguous organ, mechanical obstructions caused by foreign bodies and calculi, and injury of nerves controlling bladder contraction (neurogenic bladder)


Obstruction morphology

-in early stages, only thickening of the bladder wall due to smooth muscle hypertrophy
-with progressive hypertrophy the individual muscle bundles greatly enlarge and produce trabeculation of the bladder wall
-in course of time, crypts form and may be converted into diverticula


Gonococcal Urethritis

-one of the earliest manifestations of venereal infection


Nongonococcal urethritis

can be caused by several different organisms
-various strains of chlamydia are the cause of 25-60% of nongonococal urethritis in men and about 20% in women


Urethritis is often accompanied by

-cystitis in women and prostatitis in men


Reactive arthritis

-associated with the clinical triad of arthritis, conjunctivitis, and urethritis


Urethral caruncle

-inflammatory lesion that presents as a small, red, painful mass about the external urethral meatus, typically in older females
-inflamed granulation tissue covered by an intact but extremely friable mucosa, which may ulcerate and bleed with the slightest trauma


Benign epithelial tumors of the urethra include

-squamous and urothelial papillomas, inverted urothelial papillomas, and condylomas


Hypospadias and epispadias

-malformation of the urethral groove and urethral canal may create an abnormal urethral opening either not he ventral surface of the penis (hypospadias) or on the dorsal surface (epispadias)
-may be associated with failure of normal descent of the testes and with malformations of the urinary tract
-may cause abnormal obstruction and increased risk of ascending UTIs



-when the orifice of the prepuce is too small to permit its normal retraction
-may result from anomalous development but is more frequently the result of repeated attacks of infection that cause scarring of the preputial ring
-interferes with cleanliness and permits accumulation of secretions and detritus under the prepuce, favoring the development of secondary infections and possibly carcinoma


Inflammations of the penis

-almost invariably involves the glans and prepuce and include a wide variety of specific and nonspecific infections
-sexually transmitted infections
-Most cases occur as a consequence of poor local hygiene in uncircumcised males, in some the accumulation of desquamated epithelial cells, sweat, and debris, termed smegma, acts as local irritant



-infection of the glans and prepuce caused by a wide variety of organisms
-Candida albicans, anaerobic bacteria, Gardnerella, pyogenic bacteria most common


Condyloma Acuminatum

-bening sexually transmitted wart caused by HPV
-related to common wart and may occur on any moist mucocutaneous surface of the external genitals in either sex
-HPV type 6 and less frequently 11 are most frequent agents
-may occur on the external genitalia or perineal ares
-on the penis the lesions occur most often about the coronal sulcus and inner surface of the prepuce


Condyloma Acuminatum lesions consist of

-single or multiple sessile or pedunculate, red papillary excrescences that may be up to several mm in diameter
-branching, villous, papillary connective tissue stroma is covered by epithelium that may have considerable superficial hyperkeratosis and thickening of the underlying epidermis (acanthuses)
-cytoplasmic vacuolization of the squamous cells (koilocytosis) is noted


Condyloma Acuminatum tend to

recur, but rarely progress into in situ or invasive cancers


Peyronie Disease

-results in fibrous bands involving the corpus cavernous of the penis
-lesion results in penile curvature and pain during intercourse


Carcinoma In Situ of the Penis

-Bowen disease and bowenoid populaces
-strong association with infection by high-risk HPV, most commonly type 16


Bowen disease

-occurs in the genital region of both men and women, usually in those older than 35 years old
-in men tends to involve the skin of the shaft of the penis and scrotum


Bowen disease gross appearance

-solitary, thickened, gray-white, opaque plaque
-can also manifest on the glans and prepuce as single or multiple shiny red, sometimes velvety plaques


Bowen disease histologically

epidermis is hyperproliferative, containing numerous mitoses, some atypical
-the cells are markedly dysplastic with large hyper chromatic nuclei and lack of orderly maturation


Bowen disease transforms into

-infiltrating squamous cell carcinoma in approximately 10% of patients


Bowenoid papulosis

-occurs in sexually activity adults
-younger age of affected patients and its presentation is multiple reddish brown papular lesions
-virtually never develops into an invasive carcinoma and in many cases regresses spontaneously


Squamous cell carcinoma of the penis

-associated with poor genital hygiene and with high-risk HPV infection
-usually found in patients ages 40-70
-accounts for less than 1% of cancers in males in the U.S. but may be more in Asia, Africa, and South America
-circumcision confers protection
-HPV DNA type 16 more common; but also type 18
-Cigarette smoking elevates risk


Squamous cell carcinoma of the penis usually begins on

-the glans or inner surface of the prepuce near the coronal sulcus


Papillary squamous cell carcinoma of the penis

-simulate condylomata acuminata and may produce a cauliflower-like fun gating mass


Flat squamous cell carcinoma of the penis

-appear as areas of epithelial thickening accompanied by graying and fissuring of the mucosal surface
-with progression, an ulcerated papule develops


Verrucous carcinoma

-exophytic well-differentiated variant of squamous cell carcinoma that are locally invasive, but rarely metastasize