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Renal-Path
Pathology of the Urinary Tract
58
Pathology
Graduate
10/26/2010

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Cards

Term
Structures formed by the Urogenital Sinus
Definition

Bladder

Urachus

Proximal Urethra

Term
What is the embryological origin of Ureters, Distal Urethra, and Bladder Trigone
Definition

Ureters: Mesodermal from Mesonephric Ducts

Trigone: Mesodermal from Mesonephric Ducts

Distal Urethra: Ectodermal

Term
How many cell layers thick is the transitional epithelium @ the Renal Pelvis, Ureters, Bladder
Definition

Renal Pelvis: 2-3

Ureters: 3-5

Bladder 3-7

Term
What is the epithelium of the bladder trigone
Definition

Transitional in men and most women

Squamous in some women

Term
What is a common bladder problem in multiparous women?
Definition
Cystocele from prolapse uterus putting tension on the bladder
Term
Do double ureters have separate outflows tracts from the kidney and separate inflow tracts to the bladder?
Definition
Many have separate outfow tracts from the kidney, but most only have one combined inflow tract to the bladder
Term
What is the most common cause of hydronephrosis in children
Definition
Uretopelvic Junction obstruction
Term
What is congenital hydroureter and what is its probable cause? What is a common cause of non-congenital hydroureter
Definition

Dilation of the ureter caused by problems innervating the ureter musculature

Non-Congenital: Obstruction

Term
What are the complications of Uretitis
Definition
None except chronic can lead to granular mucosa from lyphocytic follicles "Utertitis Granularis" or fine cysts "Uterititis Cystica"
Term
What are the tumors of the ureter
Definition

Benign: Leiomyoma, Fibroepithelial Polyps

Malignant: Transitional Cell Carcinoma

 

Term
What are the major sites of ureter obstruction
Definition

Renal Pelvis

Crossing the Iliac Vessels

Entering the Bladder

Term
What is the histology of Sclerosing Retroperitoneal Fibrosis
Definition
Lymphocytes, plasmas, eosinos, and fibrosis
Term
What are the causes and complications of Sclerosing Retroperitoneal Fibrosis
Definition

Causes: Idiopathic-Ormond disease(most common), Drug or Malignancy Induced

Consequences: Hydronephrosis

Term
What is the lymph drainage of the bladder?
Definition
External and Internal Iliac Nodes
Term
What are some possible complications from incomplete closure of the urachus
Definition

Patent Uracus: Infection

Urachal Cyst: Adenocarcinomas

 

Term
What is Exstrophy
Definition
Absent Anterior Bladder Wall and lower abdominal wall
Term
What are the most common locations of bladder diverticulosis?
Definition
Trigone, Above Trigone, Urachus Site
Term
What are some possible complications of bladder diverticulosis
Definition
Malignancy, Infection, Perforation, Lithiasis
Term
Why do lesions to the bladder most commonly carry a worse prognosis
Definition
Early Detection is rare
Term
What is the triad of Cystitis Symptoms
Definition

Dysuria

Increased Frequency of Urination

Lower Abdominal Pain

Term
What patients carry the most risk for cystitis
Definition
Lower Urinary Obstructions: Lithiasis, Pregnancy, BPH
Term
What are the common bacteria of Cystitis
Definition
Enterobacter, Klebsiella, Proteus, Candida albicans
Term
What is a complication specific to Proteus Cystitis?
Definition
Staghorn Calculi
Term
What is Hunner's Ulcer and how is it diagnosed
Definition

Chronic Cystitis

Diagnosis: Linear ulcers with fibrosis seen best when bladder is distended

Term
What is Malacoplakia, what is the most common cause?
Definition

A cystitis with PAS+ Inclusions containing crystalline laminations of bacterial reminants named "Michaelis-Gutmann Bodies"

Cause: Chronic E.coli or Proteus Infection

Term
What is Polypoid cystitis, what is its most likely cause and what malignancy can it be confused with?
Definition

Bladder Mucosal irritation causes polypoid projections

Caused by indwelling catheters mostly

Commonly confused with Papillary Urothelial Carcinoma

Term
What are some metaplastic responses of the bladder to irritation
Definition

Brunn's Buds: Proliferative Invaginations

Cystitis Cystica: Brunn's Buds With Eosinophillic material

Cystitis Glandularis: Brunn's Buds forming Glands

Squamous Metaplasia

Nephrogenic Metaplasia(Adenoma): Polypoid Lesions with small tubules

Term
What are the precursor lesions to Urothelial Carcinoma
Definition

Papillary Urothelial Hyperplasia

Flat Urothelial Carcinoma

Term
What is the major determinant of prognosis in Bladder Carcinoma
Definition
Spread into the Detrussor Muscle
Term
What are the different Grades of Urothelial Carcinomas and how would you differentiate each?
Definition

Papillary Urothelial Neoplasm of Low Malignant Potential: Umbrella cells, >7 cells thick

Papillary Urothelial Carcinoma Low Grade: No umbrella and Atypical appearance

Papillary Urothelial Carcinoma High Grade: Pleomorphic, Necrosis, Ulceration

Term
Describe the most typical bladder cancer patient
Definition
White Male 50-80 yrs old
Term
Risk factors for bladder cancer
Definition

Smoking

Radiation

Cyclophosphamide

Aniline Dyes

Schistosoma Haematobium

Term
What are the pathway models of Bladder carcinogenesis?
Definition

Papillary: 9q/9p deletions then p53

Carcinoma In-Situ: P53 then Chromosome 9 deletion

Term
Are bladder Carcinomas mostly Monoclonal
Definition
Yes, shown by X-inactivation
Term
What is the typical presentation of bladder carcinoma
Definition

Painless Hematuria and Cystitis

 

Term
How are Localized Papillary, Multifocal, and High-grade/CIS/Recurrent/Invasive Carcinomas treated differently
Definition

Papillary: resection and monitor

Multifocal: Topical Chemotherapy

High-grade etc. : BCG following Chemo

Term
When is cystectomy necessary for bladder carcinoma?
Definition

Refractory to BCG

Detrussor involvement

CIS in Prostate

Term
Prognostic Factors for bladder carcinoma
Definition

Grade

Lamina Propria Invasion

Carcinoma in Situ

Others: Neck/Dome are worse, Antigen Loss, DNA Ploidy, High P53 Expression

 

Term
What are the most common benign and malignant mesenchymal tumors of the bladder
Definition

Benign: Leiomyoma

Malignant: Rhabdomyosarcoma(Children)

Leiomyosarcoma(Adults)

Term
What is the most common pathogens of urethritis
Definition
Gonococcal, Chlamydia, Mycoplasma
Term
What is a caruncle?
Definition
Vascularized Fibroelastic bundle outside or within the External Urethral Meatus
Term
What patients are more likely to get a Angiomyolipoma of the kidney and what is the source cell/marker
Definition

Tuberous sclerosis patients

Pericyte derived-Neural Crest(HMB-45)

Term
Describe the appearance of a Oncocytoma
Definition

Organoid(nest-like) growth with central hylanized scar

Hale's/PAS (-)

Term
What are the classic symptoms of  Renal cell carcinoma
Definition

Hematuria

Flank Pain

Abdominal Mass

Term
What is Stauffer Syndrome
Definition

Hepatic dysfunction from non-invading Renal cell carcinoma

 

Term
What are the risk factors for renal cancer?
Definition

Tobacco

Obesity

HPTN

Estrogen

Asbestos

CRF/Cystic Disease

Tuberous Sclerosis

Familial: VHL(Clear-Cell), Met(Papillary)

Term
What are the familial diseases associated with Renal Carcinoma
Definition

Von Hippel-Lindau Syndrome (Hemoangioblastomas(Brian/Eye), Renal Cysts, Clear Cell Carcinoma): VHL gene (Tumor Supressor)

Hereditary Clear Cell Carcinoma (Only Renal Clear Cell Carcinoma): VHL gene

Hereditary Papillary Carcinoma: Met protooncogene

Term
How do you differentiate the renal cell carcinomas
Definition

Clear Cell: Clear Cyoplasm, PAS(+), Hale's(-)

Papillary: Papillary growth, PAS/Hales (-), Psammoma Body

Chromophobe: Vegetable-like, PAS(-), Hale's(+)

Term
What renal carcinoma is more common in dialysis patients
Definition
Papillary Carcinoma
Term
What is the pattern of growth of the Collecting duct carcinoma
Definition
Hobnailed
Term
What are the most common metastatic site of Renal carcinoma
Definition

Lungs 50%

Bones 33%

Nodes

Liver

Adrenal

Brain

Term
Are the Ureters intraperitoneal, retro or both?
Definition
Retroperitoneal
Term
Where does the lymph from the bladder neck drain?
Definition
Sacral and Common Iliac Nodes
Term
How would you differentiate urothelial papillary carcinoma from its precusor lesion?
Definition

Papilloma: <7 Cells thick

Papillary Carcinoma of low Malignant Potential: >7 cell layers thick

Term
What is the precursor lesion to Adenocarcinoma of the bladder?
Definition
Cystitis Glandularis
Term
What are the benign neoplasms of the Kidney
Definition

Renal Papillary Adenoma

Angiomyolipoma

Oncocytoma

Term
What renal carcinoma can invade the IVC and even the heart
Definition
Papillary
Term
What neoplasms are analgesic nephropathy associated with
Definition
Bladder and renal pelvis urothelial carcinoma
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