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56 Cards in this Set

  • Front
  • Back
Congenital disorders of the renal pelvis and ureter (3)
Ectopic ureter
Ureteropelvic Junction Obstruction
Congenital Megaureter
Exstrophy of the bladder is a developmental abnormality characterized by the absence of a portion of the lower abdominal wall and the anterior wall of the bladder.

• Abrasion by clothing and the continuous escape of urine result in chronic infection of the bladder mucosa.
• Continuous leakage of urine, persistent/recurrent local infection, + increased risk of ascending UTI.
• Substantial incidence of neoplastic transformation of the metaplastic urothelium  adenocarcinoma, squamous cell carcinoma, transitional cell carcinoma.
Define cystitis.
• Cystitis refers to inflammation of the urinary bladder and is the most commonly encountered clinical disorder of this organ.

SEcondary to infection of bladder; coliform bacteria (e.coli, proteus, pseudomonas, enterobacter)
Females>males (short urethra)
Define Chronic Interstitial Cystitis (Hunner Ulcer)
• A disorder of unknown cause, typically affecting middle-aged women, that is characterized by transmural inflammation of the bladder wall and is occasionally associated with mucosal ulceration (Hunner ulcer).

Typically doesn't respond to all forms of therapy. Urine cultures negative.
• An uncommon inflammatory disorder of unknown cause that features macrophage-containing mucosal plaques.

Often associated with a UTI by E.coli.
Some of these macrophages have laminated, basophilic calcospherites called MICHAELIS-GUTMANN BODIES.
Simple hyperplasia
an increased # of cell layers in the mucosal transitional epithelium.

FLAT configuration—no papillary features nor invaginations into the lamina propria.
Brunn's buds
bulbous invaginations of the surface urothelium into the lamina propria
Brunn's nests
urothelial cells have detached from the surface and are seen within the lamina propria
Cystic lesions of the urinary tract
small slits or round spaces in otherwise solid Brunn nests
Cystitis glandularis
lesions of the bladder mucosa characterized by metaplastic glandular structures lined by mucin-secreting columnar epithelial cells.
Carcinoma in situ [bladder]
full-thickness, malignant changes confined to a flat (nonpapillary) urothelium.

Lesion characterized by a urothelium of variable thickness that exhibits cellular atypia of the entire mucosa, from the basal layer to the surface.
Epidemiology of transitional cell carcinoma (bladder)
High frequencies: urban whites in US and W. europe.

low prevalence in japan and american blacks.

Pathogenesis of transitional cell carcinoma (bladder)
increased risk identified among workers in the leather, rubber, paint, and organic chemical industries.

Smoking associated.

also reported in the setting of analgesic abuse (phenacetin).
In order of decreasing frequency, metastases of bladder cancer occur:
regional and periaortic lymph nodes
classic cause
and more common causes today.
Classic cause: neisseria gonorrhoeae

TOday: chlamydia sp., e. coli, mycoplasma.
Reiter syndrome
a complex of unknown cause, characterized by

Define urethral caruncle.
• An inflammatory lesion near the female urethral meatus that produces pain and bleeding.

only in women, after menopause

exophytic and often ulcerated polypoid mass.
Define cryptorchidism
• Refers to the failure of a testis to descend completely into its normal position within the scrotum.

Reduced diameters of seminiferous tubules, decreased # of germ cells, eventually the tubules are reduced to hyalinized cords of CT.

The risk of developing GERM CELL TUMORS if untreated is increased 35-fold.
• Refers to an acute or chronic inflammation of the testis, frequently in association with inflammation of the epididymis.

Gram-negative bacterial orchitis is the most common form.

Syphilis and mumps can cause.

Granulomatous orchitis: unknown cause, infrequent disorder of middle-age men, presents as painful enlargement of the testis or testicular induration.
Torsion of testis
produces severe pain and infarction of testicular germ cells.

presents after vigorous physical exercise.

often associated with congenital abnormalities that contribute to increased motility of the testis/epididymis.

Swollen, firm tests shows hemorrhagic infarction.
Germ cell tumors.
2 major histogenetic categories: germ cell tumors and gonadal stromal/sex cord tumors.

These originate from the neoplastic transformation of germ cells and reflect their capacity to differentiate along many histogenetic lines-- these tumors are characterized by somatic differentiation, extraembryonic differentiation, or both.
Germ cell tumors occuring in extragonadal sites.
midaxial locations -- mediastinum and sacrococcygeal region.

Reflects the neoplastic transformation of germ cells that migrated from their endodermal yolk sac origin to these sites.
1/2 of all germ cell tumors.
not found before puberty.
most are the "classic type": solid, gray-white grwoth that tends to bulge from the cut surface of the testis.

Exquisitely sensitive to radiation.
Embryonal Carcinoma
2nd most common testicular germ cell tumor.
Doesn't occur before puberty, ages 20-35

form sheets of cells, with clefts, acini, and papillary structures
Testicular Teratoma
Testicular teratomas are germ cell tumors characterized by tissues from all 3 germ layers: the ectoderm, the endoderm, and the mesoderm.
Mature teratoma
solid, multicystic lesion that enlarges the testis.

haphazard juxtaposition of a bewildering variety of cells and organoid structures-- these are dispersed in a fibrous or myxoid stroma.
immature teratoma
must more common in ADULTS.

tissues are less differentiated and more primitive that in mature teratomas.
teratoma with malignant transformation
presence of a squamous cell carcinoma or a sarcomatous mesenchymal component.
Most important predictor for the biological behavior of a testicular teratoma:
age of patient.

adult --> should be considered potentially malignant.

infants/childrens --> invariably benign.
Yolk sac tumor (endodermal sinus tumor)
most common germ cell tumor in infants.

histologic similarity with normal structures of rat placenta.

enlarge the testis. tumor cells surround the SCHILLER-DUVAL body, which consists of a microcyst containing a glomerulus-like structure with a central fibrovascular core.

a-fetoprotein and a1-antityrpsin can be found in the cytoplasm.

don't metastasize.
Testicular Choriocarcinoma
a highly malignant testicular tumor that represents germ cell extraembryonic differentiation to the components of the placenta, namely syncytiotrophoblast and cytotrophoblast.

small, painfless nodule in testis.
large, multinucleated giant cells of irregular configuration, with abundant vacuolated cytoplasm that contains human chorionic gonadotropin.
polygonal cells, with round, hyperchromatic nuclei and sparse cytoplasm; clustered with syncytiotrophoblasts.
mixed germ cell tumors
exhibit more then 1 type of neoplastic germ cell. most frequent combinations:

teratoma + embryonal carcinoma (teratocarcinoma)
teratoma, embryonal carcinoma, + seminoma
embryonal carcinoma + seminoma
• A collection of serous fluid in the scrotal sac and the most common cause of scrotal swellings.
• Either congenital or associated with a patent processus vaginalis or acquired secondary to an inflammatory disorder of the epididymis or testis.
• A cystic enlargement of the efferent ducts or the ducts of the rete testis and is clinically indistinguishable from a hydrocele.
• The presence of SPERM in the fluid of a spermatocele differentiates this cystic enlargement from a hydrocele.
• Dilatation of the testicular vein and is usually asymptomatic.
• May be accompanied by testicular atrophy and result in infertility.
• Acute epididymitis: inflammation of the epididymis
• Most cases in young men are due to infection N. gonorrhoeae and Chlamydia trachomatis.
o Epididymitis caused by N. gonorrhoeae is a common cause of male INFERTILITY.
• In older men, E. coli from associated UTI’s is the most common causative agent.
• Patients have intrascrotal pain and tenderness, with or without associated fever.
bacterial prostatitis
usually follow lower UTI's and result from the reflux of infected urine into the prostate.

acute: caused by gram-negative bacteria, esp. e. coli

chornic: lymphocytes, plasma cells, and mac's are the rule.
nonbacterial prostatitis
no causative agent is identified.

men >50

dilated glands filled with neutrophils and foamy macrophages; surrounded by chronic inflammatory cells.
Nodular hyperplasia of the prostate (benign prostatic hyperplasia)
a common disorder characterized CLINICALLY by enlargement of the gland, with obstruction of the flow of urine through the bladder outlet, and PATHOLOGICALLY by proliferation of glands and stroma.
what are the 3 epidemiologic factors related to the incidence of prostatic nodular hyperplasia?
geography-less frequent in orient, most frequent in w. europe and US
race: blacks>whites
age: clinical prostatism peaks in 70's
pathogenesis of nodular hyperplasia of the prostate.
there is evidence that growth of prostatic tissue is stimulated by dihydrotestosterone (DHT), the metabolic product of testosterine.
5 types of nodules of nodular hyperplasia of the prostate.
stromal (fibrous)
fibromyoadenomatous (most common)
what is the most freuqently employed criterion to establish the diagnosis of prostatic adenocarcinoma?
a single layer of cuboidal cells lining neoplastic acini.
Grading system for prostatic adenocarcinoma.
Gleason grading system.
high frequency of mixed tumor patterns --> sum of the grade attributed to the most prominent pattern and of the grade attributed to the minority pattern.

the lower the score, the better the outlook.
Treatment for prostatic adenocarcinoma.
Radical prostatectomy or radiation therapy.

for those whose tumors have metastasized, the principal form of therapy is hormonal = androgen deprivation.
• Refers to congenital or acquired inability to retract the prepuce.
• Increases the risk of further inflammation of the glans and prepuce.
• Circumcision is effective therapy.
opening of the urethra on the DORSAL surface of the penis.
opening of the urethra on the VENTRAL surface of the penis.
Condyloma Acuminatum
• Circumscribed, exophytic, cauliflower-like lesions that usually occur on the glans but sometimes are found on the shaft.
• Tend to spread to other sites of the anogenital region.
• Venereal (involving genital organs) warts are caused by HPV.
Squamous cell carcinoma in situ (penis)
bowen disease
erythroplasia of queyrat
bowenoid papulosis
bowen disease
dysplastic epidermal lesions on the shaft of the penis.
erythroplasia of queyrat
dysplastic epidermal lesions on the glans/prepuce of penis.
bowenoid papulosis
disease of the penile skin associated with squamous carcinoma in situ. presents clinically as multiple violaceous papules on the shaft.

HPV type 16 antigens have been demonstrated.
all lesions regress spontaneously.
Verrucous Carcinoma
doesn't usually metastasize
only in uncircumsized men.
the tumor may enlarge to form a substantial warty mass, which destroys teh end of the penis.
surgical removal usually curative.
low-grade squamous cell carcinoma.