Urinary Pathology Flashcards by Zach Visinoni

Most common cause of hydronephrosis in children is:

UPJ obstruction

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3 points of construction of the ureters

UPJ
Crossing iliac vessels
Entrance of the bladder

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Cause of congenital bladder diverticulae:

Cause of acquired bladder diverticulae:

Failure of development of normal musculature or some degree of urinary obstruction in development

Urinary obstruction - prostate hypertrophy (most common)

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3 pieces of clinical significance of bladder diverticulae

Urinary stasis -> increased risk for infection and calculi formation
Predisposition for VUR if impinging ureters
Rarely carcinomas may arise

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Extrophy occurs when…

Who gets it most?

What can happen as a result?

What is their an increased risk for?

What is the prognosis?

The anterior abdominal wall does not close properly and the bladder protrudes.

M=F, W»B

Colonic glandular metaplasia and is subject to infection.

Adenocarcinoma.

Prognosis is good.

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Urachal cysts impose an increased risk for: (2)

What is a patent urachus?

Infection and carcinomas

The suspensory ligament is hollow and a tube reaches the umbilicus.

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Triad of SX in cystitis

Other “non-classic” SX

Frequency
Dysuria
Pelvic/abdominal pain

Low-grade fever, turbid urine, some hematuria

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Complicated UTIs often occur in patients with: (2)

Anatomic/function abnormalities of the UT

Diseases that hamper the natural UT defenses

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Positive - Clinical interpretation of urine culture depends on: (4)

Specimen collection, method and handling

Number of isolates

Organisms involved

Quantity

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What are the 2 exceptions to the idea that the presence/quantity of squamous epithelial cells in urine is relevant for treatment?

Pts. on anti-microbial therapy when cultures obtained

Pts. with mycobacterial or other abnormal cystic infections

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75-90% of cystitis is caused by what organisms? (4)

E coli*
Proteus
Klebsiella
Enterobacter

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10-15% of cystitis is caused by what bacteria?

Staph saprophyticus

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Predisposing factors for developing cystitis

Bladder calculi
Urinary obstructions/structural abnormalities
DM
Instrumentation
Immune deficiency

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Radiation of the bladder can cause:

Acute/chronic irradiation cystitis

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Cystitis morphology

Usually non-specific acute inflammation w/ hyperemia of the mucosa with occasional exudate

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Patients on which medicines can get hemorrhagic cystitis?

What infection is implicated in hemorrhagic cysts?

Anti-tumor drugs, like cyclophosphamide

Adenovirus

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Interstitial cystitis (Hunner ulcer)

SX:

Most common in:

What is in culture?

What cells are found on histology?

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Chronic, persistent, painful form of cystitis.

Intermittent subrapubic pain, urinary freq/urgency, hematuria, dysuria.

30-40 y/o women.

Negative cultures

Mast cells

Malacoplakia is noted by a pattern of bladder inflammatory reaction characterized by:

What causes it?

What infection is implicated?

Who gets it most?

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3-4 cm in diameter soft, yellow, slightly raised mucosal plaques.

Defective phagosome function related to chronic infection.

E coli

F»M middle-aged, most common in immunocompromised pts.

What is a classic histological finding in malacoplakia?

What do these cause?

What else is found (other cells)?

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Michaelis-Gutmann bodies - laminated mineralized concretions in macrophages

Deposition in abnormal, enlarged lysosomes.

Foamy Mo, multinucleated giant cells, intersperesed lymphocytes, in areas forming granulomas

Polypoid cystitis is what kind of condition:

Most common cause:

What can it look like and is often misdiagnosed as?

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Inflammatory condition from irritation of the bladder mucosa

Indwelling catheters

Papillary carcinoma

Follicular cystitis

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Aggregation of lymphocytes in lymphoid follicles in the mucosa and is associated with chronic infection

Eosinophilic cystitis

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Infiltration of eosinophils that represents a nonspecific subacute inflammation, but rarely might be associated with autoimmunity or a parasitic infection or a sequel from radiation/chemo

Non-epithelial tumors of the bladder are all:

Most common of all is:

Other examples include:

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Common and benign

Leiomyoma

Lipoma, Fibroma, Neurofibroma

Malignant non-epithelial tumors of the bladder (3)

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Rhabdomyosarcoma (childhood)
Leiomyosarcoma (adults)
Lymphomas

Embryonal rhabdomyosarcoma is what kind of tumor? Has what characteristic on histology? Who is most likely to get it? Prevalence:

Malignant mesenchymal tumor Sarcoma botryoides Children, avg age 4 y/o, M=F Rare

Leiomyosarcoma is what kind of tumor? Who most often gets it? Prevalence: What can cause it?

Malignant mesenchymal tumor Avg age 60 y/o, M>F Rare Post-chemo/rads occasionally

Primary malignant lymphoma of the bladder Who gets it most? What is a common manifestation? What is it made of? Prognosis? Prevalence?

65 y/o, F>>M, most with chronic cystitis. Diffuse large B cell and MALT. Good prognosis Very rare

>90% of bladder cancers are.... 5% are.... <5% are....

Urothelial (transition) tumors SCC Sarcomas and other mesenchymal tumors

Papillary urothelial neoplasia of low malignant potential (PUNLMP) is a... Major pathological finding...

Precancerous lesion to urothelial malignancy. 15-20% of papillary tumors. Thickened epithelium covering papillary projections, with minimal atypia.

Most urothelial neoplasias are: The other 3 varieties are:

Papilloma-papillary carcinoma Invasive papillary carcinoma Flat non-invasive carcinoma (CIS) Flat invasive carcinoma

Flat lesions are more likely to cause: Papillary lesions are more likely to cause:

Discomfort Hematuria

Grade 1, 2 and 3 flat urothelial neoplasia

1 - thickened epithelium 2 - atypical hyperplasia (probably means nothing) 3 - CIS

Who is most likely to get bladder cancers?

Older white men (avg age of 73)

Common genetic factors in urothelial carcinoma (2)

Chr 9 monosomy or deletions Chr 17p deletions (bad sign)

"Dominant clinical finding and typically the only clinical finding" of urothelial carcinoma is:

Painless hematuria >40% there is mets at initial dx

Majority of pts. undergo which 2 procedures for urothelial cancer Tx

Transurethral resection (TUR) Intravesical therapy

Papillary carcinoma - high grade makes up what percent of papillary tumors? What is the reoccurence rate?

30% High rate

Most critical prognostic factor in bladder cancer is:

Stage, meaning the degree of muscle invasion

Low stage (Ta, Tis, T1) bladder cancer survival rate:

90-95% at 5 yrs. High reoccurence post Tx but it does not cause death

High stage (T2-T4) bladder cancer survival rate:

50% at 5 yrs

High grade invasive urothelial carcinoma advanced stage (T3) has what appearance grossly?

Nordular tumor that may fill the bladder lumen Hemorrhage Yellow areas representing ulceration and necrosis

What is the best way to monitor reoccurence in pts. with high-grade urothelial neoplasia? What should not be done in pts. with low grade neoplasia?

Urine cytology Instrumentation because it might stimulate the neoplasm

Urinary Pathology Flashcards

(42 cards)