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73 Cards in this Set
- Front
- Back
layers of the bladder starting closest to the lumen
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urothelium
lamina propria muscularis propria adventitia |
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2 broad types of bladder neoplasm
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epithelial (most common)
non-epithelial (mesenchymal) |
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types of benign mesenchymal bladder neoplasms
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leiomyoma
paragnaglioma fibroma plassmacytoma solitary fibrous tumor NF lipoma |
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types of malignant mesenchymal bladder neoplasms
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rhabdomyosarc
leiomyosarc lymphoma osteosarc |
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appearance of epithlial tumors in bladder
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intraluminal filling defect
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appearance of mesenchymal tumors
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smooth intramural lesion
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another name for transitional cell CA
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urothelial cancer
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most common type of bladder CA
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TCC > squamous cell > adenoCA
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pathogenesis of TCC
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direct, prolonged contact of bladder urothelium with urine containing excreted carcinogens (esp from cigarettes)
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other than cigarette smoking, other associations of TCC
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bladder stones, chronic infx, medications
pts with bladder diverticuli |
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most common location w/i bladder for TCC
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base
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types of TCC in bladder
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papillary
sessile nodular |
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at what point is TCC of bladder considered invasive
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after is goes deeper than lamina propria; once w/i muscularis layer, it is invasive
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if invasive, where does bladder TCC go
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local mets to prostate, vagina, uterus, pelvic wall
mets to pelvic LN distant mets to lung>liver>bone |
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enhancement characteristics of bladder TCC
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avidly enhance, early
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appearance of TCC on US if lesion is present
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hypoechoic
+flow |
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on MR, appearance of bladder wall/tumor in TCC
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intermed on T1 and T2
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what is a strong risk factor for squamous cell CA of bladder
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schistosomiosis
also, indewlling cath, bladder calcs, chronic infx , prior cyclophosphamide |
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most common location of squamous cell CA of bladder
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trigone and lateral bladder
bladder diverticula |
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imaging finding of squamous cell CA of bladder
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no-specific
usually sessile |
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tx of squamous cell CA
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radical cystectomy
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which prognosis is poorer: squamous cell or TCC
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squamous cell
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etiology of adenoCA of bladder
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2/3 are associated with urachal CA, 1/3 are metastatic
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how will urachal CA present clinically
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urachal d/c
mucous in the urine |
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classic associations of urachal CA
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bladder exstrophy
patent urachus pelvic lipomatosis cystitis glandularis |
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location of primary urachal CA
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bladder base > urachus
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what other types of CA can urachus present with
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80% are adeno
remainder are squamou scell and TCC |
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pathophys of adenoCA of urachus
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urachus is lined with transitional epihelium. adenoCA is thought to arise in areas of intestinal metaplasia or from rests of embryonic hhindgut epithelium within urachus
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is adenoCA of bladder cystic or solid
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both in 84% of cases
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where is urachal CA most often
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outside of the bladder
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pathology of small cell bladder CA
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dedifferentiated neuroendocrine cells
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is small cell bladder CA agressive
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yes, highly agressive
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classic appearance of small cell bladder CA
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large, polypoid or nodular and may have ulcerated surface
+- central necrosis or cystic change patchy enhancement |
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most common location for small cell bladder CA
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lateral wall of bladder
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tx of small cell bladder CA
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radical cystsectomy and pelvic LN dissection
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most common location of bladder carcinoid
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bladder neck or trigone
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T or F
carcinoid syndrome is common in carcinoid bladder tumors |
false, no known reports
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how often is carcinoid of bladder metastatic
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30%
remainder are benign |
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most common mesenchymal tumor of bladder
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leiomyoma
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leiomyoma more common in males or females
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equal
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general appearance of bladder leiomyoma
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small solid homogeneous mass +/- cystic degeneration
muscularis layer preserved |
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MR appearance of bladder leiomyoma
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intermed T1
low T2 variable enhancement |
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T or F
leiomyoma of bladder can degenerate into leiomyosarc |
false, but it does have to be bx'd to confirm dx
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most common mesenchymal malignancy in bladder
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leiomyosarcoma
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risk factors for leiomyosarc
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after radiation tx or cyclophosphamide, increased risk
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genereal appearance of leiomyosarc
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necrosis is more common
poorly circumscribed otherwise, similar to leiomyoma |
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tx of leiomyosarc
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resection
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most common bladder tumor in children
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rhabdomyosarcoma
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where can rhabdomyosarcoma occur
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anywhere in body except bone
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associated anomalies seen in pts wiht rhabdomyosarc
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congenital brain anomalies
NF nephroblastomatosis |
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general imaging features of rhabdomyosarc
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lrg nodular filling defect or mass
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most common location of rhabdomyosarc in bladder
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bladder base
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tx of rhabdomyosarc
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chemo
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#1 GU site of neurofibroma
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bladder
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which NF type is associated with bladder neurofibromas
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NF 1
although they can also occur in isolation |
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where are bladder neurofibromas most commonly located
why |
trigone
nerve plexus enters near trigone and neurofibromas arise from nerve plexus |
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types of bladder neurofibroma
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localized
diffuse plexiform |
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appearance of plexiform neurofibroma
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nodules on thickened nerve and branches occur
has a target appearance on T2 (caused by fibrosis surrounded by myxoid stroma) the stroma enhances |
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what is the proper name for a pheo arising outside of the adrenal gland
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paraganglioma
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clinical presentation of bladder paraganglioma
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catecholamine release during micturition
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location of paraganglioma of the bladder
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can be anywhere
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bladder paraganglioma:
benign or malig |
benign mostly
5-18% chance of malign |
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general imaging features of bladder paragangliom a
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solid homogeneous lobulated well marginated mass
may have cystic areas, necrosis, or hemorrhage submucosal location marked enhancement ring calcifications |
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MR characteristics of bladder paraganglioma
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low T1
mod high on T2 |
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tx bladder paraganglioma
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tx with local excision after alpha blockade
Long term f/u rec'd. |
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add'l studies to perform in pt with paraganglioma to determine extent of dz
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MIBG
PET wiht fluorodopamine (analogue of dopamine) MR |
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why is bladder lymphoma very rare
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there is no lymphoid tissue in bladder
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who is most likely to get hemangiomas of the bladder
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kids > adults
can be isolated or assoc with klippel-trenaunay-weber syndrome or sturge-weber syndrome |
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most common type of hemangioma in bladder
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cavernous hemangioma
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general imaging characteristics of hemangioma (bladder)
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hypervascular
low T1, high T2 |
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solitary fibrous tumor - general imaging features
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solid enhancing mass
low T2 signal |
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path of solitary fibrous tumor
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whorled, fibrotiic surface, similar to leiomyom a
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tx of solitary fibrous tumor
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partial cystectomy
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