Pathology Of The Lower Urinary Tract

Front 1

UG embryology

Back 1

bladder derived from UG sinus (meso & endoderm)
urachus connects fetal bladder to umbilicus

Front 2

Ureter Developmental Abnormalities

Back 2

Rare 2-3%
bifid ureter w/ or w/o double pelvis
ureteropelvic junction obstruction (L side in males or pregnant females)
congenital hyroureter or megaureter

Front 3

Urinary bladder abnormalities

Back 3

Diverticula (acquired or congenital)
exstrophy (--> chronic inflammation --> adenocarcinoma)
veisoureteral reflux
congenital fistulae
persistent urachus

Front 4

Back 4

urinary bladder w/ diverticulum (congenital or acquired)

Front 5

Back 5

extrophy of bladder

Hint 5

--> chronic infections --> adenocarcinoma

Front 6

Back 6

normal urothelium (5-7 cell layers thick)

Front 7

UTI

Back 7

lower tract infections are ascending (Mycobacterium tuberculosis is the exception)
Bacterial - coliforms (e. coli, proteus, klebsiella, enterobacter, chlamydia, mycoplasm)
fungal - candida, cryptococcus
virus - adenovirus, BK
parasites - s. haematobium, t. vaginalis

Front 8

Back 8

Polyoma or BK virus infection
"frosted glass" nuclear inclusions w/ clumped native chromatin

Front 9

Back 9

schistosomiasis
note granulomas

Front 10

Back 10

schistosomiasis
note granulomas

Front 11

UT inflammation

Back 11

acute - frequency, abd pain, dysuria, PMN infiltrate, mucosal hyperemia, exudative or ulcerative
chronic - lymphoplasmacytic w/ fibrosis, follicular and eosinophilic variants
acute or chronic cystitis may cause pyelonephritis

Front 12

Back 12

acute cystitis w/ exudate

Front 13

Interstitial cystitis

Back 13

chronic inflammation and fibrosis of all layers of the bladder wall, more common in women, associated w/ autoimmune dz

Front 14

Back 14

Malacoplakia
mucosal plaques containing foamy macrophages
Michaelis-Gutmann bodies

Hint 14

associated w/ immunocomp pts, e.coli, defects in phagosome activity

Front 15

Back 15

Cystitis glandularis
nests of downward growing urothelium, may become cystic, intestinal metaplasia may occur

Hint 15

incr risk of adenocarcinoma

Front 16

Back 16

Cystisis cystica
nests of downward gorwing urothelium, may become cystic, extensive metaplasia

Hint 16

incr risk adenocarcinoma

Front 17

Back 17

intestinal metaplasia

Hint 17

incr risk of adenocarcinoma w/ metaplasia

Front 18

Back 18

chemotherapy effect
enlarged cells, degenerative changes (cytoplasm fraying and nuclear smudging), crystals

Hint 18

hemorrhagic cystitis associated w/ cyclophosphamide, radiation, adenovirus, causes gross hematuria

Front 19

UT neoplasms

Back 19

high M&M, 50k pts/yr
95% are urothelial (location % dependent on surface area)
risk factors - tobacco, arylamines, chronic irritation, phenacetin, cyclophosphamide
Chromosome 9 alterations - low grade, noninvasive (tumor suppressor gene)
Chromosome 17 - p53, invasive lesions
Chromosome 13 - Rb gene, invasive
Chromosome 14 - flat and invasive

Front 20

Back 20

benign papilloma
papillary growth pattern, thin epithelium, orderly growth

Front 21

Back 21

urothelial neoplasm of low malignant potential
papillary architecture and foacl thickening of epithelium w/ areas of maturation

Front 22

Back 22

low grade urothelial carcinoma
complex branching architecture, epithelial thickening and crowding

Front 23

Back 23

low grade urothelial carcinoma
crosded group of hyperchromatic cells
clumped cells in urine = cancer

Front 24

Back 24

urothelial carcinoma of the renal pelvis

Hint 24

don't be fooled! its still the renal pelvis --> still urothelial

Front 25

Back 25

low grade urothelial carcinoma
papillae are beginning to fuse

Front 26

Back 26

low grade papillary urothelial carcinoma
epithelial thickness, lack of maturation, mitosis off bm

Front 27

Back 27

high grade urothelial carcinoma
pleomorphism, discohesion at edges, necrosis

Hint 27

papillary, nodular, both
80% show invasion of muscularis, anaplasia, cellular discohesion, squamous or glandular differentiation
ulceration may be present

Front 28

Back 28

high grade papillary urothelial carcinoma

Hint 28

papillary, nodular, both
80% show invasion of muscularis, anaplasia, cellular discohesion, squamous or glandular differentiation
ulceration may be present

Front 29

Back 29

urothelial carcinoma in situ

Front 30

Back 30

urothelial carcinoma in situ
if you understand why or can see a basement membrane please enlighten me

Front 31

urothelial carcinoma

Back 31

presents: PAINLESS hematuria, pyelonephritis or hyronephrosis (depending on location)
high rate of recurrence
papillomas and low grade have 98% 10 yr survival
high grade cancers have 40% 10 yr survival
pure squamous cell is poor prognosis

Front 32

obstructive lesions

Back 32

sclerosing retroperitoneal fibrosis - idiopathic, late/middle age
congenital narrowing, inflammatory stricture, fibrosis, contracture, compression, neurogenic

Front 33

urethral inflammation

Back 33

gonococcal v. nongonococcal
associated w/ ascending cystitis

Front 34

urethral neoplasms

Back 34

caruncle - inflammatory pseudotumor in older women (bleeds)
papillomas - viral, at meatus
carcinoma - rare, older women, squamous near meatus, aggressive