Lower UT & bladder path
most common cancer of UT
TCC-Adenocarcinoma
most common cause of hydronephrosis
UPJ obstruction
what stain do you use to visualize phosphate?
VON KOSSA stain *see basophilic rounded CaP deposits
inflammation of bladder
acute or chronic (more common in men w BPH) cystitis *E coli, Proteus -IC patients -Schistosomiasis -radiation cystitis -tuberculous cystitis
struvite stones
aka triple stone -Mg, NH3, PO4 linked to renal INFECTION *formed in alkaline urine
acute phosphate nephropathy
can be due to colonoscopy prep
cystinuria
cystine leaks into urine due to inherited disorder -> recurring stones
flat non invasive urothelial carcinoma
cytologic changes no BM invasion
exstrophy of bladder
due to developmental failure of anterior abdominal wall *complication = adenocarcinoma=TCC
hypercalcemia
due to excess calcium intake *can lead to renal failure & pyelo
secondary gout
due to leukemia, lymphoma, lead, gout *uric acid stones *formed in acid urine pH
bilateral hydronephrosis
due to path in urethra or bladder
tumor/like lesions in ureter have
fibroepithelial polyps-benign *malignant = urothelial carcinoma common in kids
renal calculi
flank pain, hematuria, M>F pathogenesis: -supersaturation -absence of normal stone inhibitors -presence of infection
urothelial tumors
flat or papillary invasive or noninvasive (CIS)
metaplastic lesions-cystitis cystica
fluid filled cystic spaces lined by flattened urothelium
metaplastic lesions-cystitis glandularis
glandular structures: transitional epithelium transforms into columnar epithelium
when are pelvis & calyces dilated?
hydronephrosis
pathologic changes due to urinary obstruction
hydronephrosis papillary atrophy cortical atrophy interstitial fibrosis
ulcer
invasive tumor
exophytuc cauliflower like tumors
larger tumors, may be invasive
what do you see in follicular cystitis
lymphoid follicles
high grade papillary urothelial carcinoma
mitotic figures loss of polarity invasion into muscular layer ulceration & necrosis
polypoid papillary cystitis
most often seen w indwelling catheters *see multiple small polypoid friable nodules
malacoplakia
occurs in chronic bacterial cystitis -yellow mucosal plaques -foamy macrophages (+PAS) display intralysosomal laminated calcified concretions - MG bodies
low grade papillary urothelial carcinoma (non invasive)
orderly no invasion
non invasive papillary tumor
originate from urothelial hyperplasia
diverticula
outpouchings of bladder
sx of hydronephrosis
pain hematuria infection calculi
interstitial cystitis aka chronic pelvic pain syndrome
painful form of chronic cystitis -pain & dysuria in the absence of infection
features of urothelial carcinoma
painless hematuria prognosis depends on grade/stage RF: smoking, industrial carcinogens, Schistosoma hematobium, deletions of 9, 17, 13, 11, 14
nephrogenic adenoma of the urinary bladder
shed renal tubular cells that implant at sites of injured urothelium -> resembles renal tubules *also see BV & inflammatory cell proliferation
papillary tumors
small tumors
what is Schistosoma haematobium associated w?
squamous cell carcinoma (which have worse prognosis than TCC)
invasion into LP
worsens prognosis esp if detrusor muscle layer
light chain cast nephropathy
-bence jones proteinuria -amyloidosis -hypercalcemia, hyperuricemia
uretral obstruction secondary to
-calculi -clots -strictures -tumors -neurogenic bladder dysfunction -sclerosing retroperitoneal fibrosis -uterus -BPH
ureteritis
-not associated w infection -form germinal centers in subepi regions -produce ureteritis follicularis = fine granular mucosal surface or ureteritis cystica = flattened urothelium; scattered fine cysts
urate nephropathy types
1. acute from chemo 2. chronic from gout 3. nephrolithiasis: stones
unilateral hydronephrosis
1. extramural -pressure on ureter -retroperitoneal fibrosis 2. intramural -stenosis or achalasia of pelvi-ureteric junction 3. intraluminal -calculus -congenital folds
types of stones
1. renal calculi--Ca containing 2. struvite 3. uric acid (not radio opaque, associated w gout) 4. cystine stones
flat lesion
CIS