URINARY BLADDER PATHOLOGY.pptx

8/14/2019 URINARY BLADDER PATHOLOGY.pptx

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Benign Proliferative and

Metaplastic Urothelial Lesions


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Benign Proliferative and Metaplastic

Urothelial Lesions

Occurs mostly in the urinary bladder (although

may be found in the entire length of urinary

tract)

a/wchronic inflammation (caused by UTI),

calculi, neurogenic bladder.

Greater riskurothelial bladder carcinoma


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Pathological types

Cystitis cystica (CC). CC lined by Transitionalepithelium. Metaplasia of transitional -> cuboidalor columnarcystitis glandularis (with increasedrisk of ADENOCARCINOMA)

Squamous metaplasia -> due to chronic injury orinflammation(particularly when it is associatedwith calculi)

Nephrogenic metaplasia (due to inplants detachedrenal tubular cells)

Brunn Buds and nest. Just like keratin pearl.


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Tumors of the Urinary Bladder

INTRODUCTION


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Important facts

Most commonest site of Urinary tract tumors.

Occur in older patient: median age 65 (rare under50 yo)

Commonest type -> urothelial malignantneoplasm

Rare: SCC, adenocarcinoma, sarcomas

If local treatment is applied -> risk for recurrence

Site: posterior and lateral aspect of the bladder Malignant tumor: papillaryor flat. Invasive or

non-invasive.


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Risk factors

Cigarette smokingpolycyclic hydrocarbon

Occupational health hazards -> dye industry

(aniline), rubber, leather, paint.

Parasitic infectionsschistosoma

Drugscyclophosphamide, analgesics

Radiation therapy- cervical, prostate or rectalcancer.


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Urothelial Tumor


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Represents about 90% of bladder tumor.Commonly reported is Urothelial Malignantneoplasm

Tumor that arises from the urothelium(transitional epithelium).

Can occur anywhere along the urinary tract,

but the commonest site is urinary bladder. Location; posterior and lateral aspect of the

bladder


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Precursor lesions and Prognosis

Two distinct precursor lesions to invasive

urothelial carcinoma; non-invasive papillary

tumor and flat non-invasive urothelial tumor.

Prognosis: how far invasion had happened.

Invasion of the lamina propria worsens

prognosis

Invasion of the muscular propria: there is 30%

5-year mortality rate.


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Grading of Urothelial Tumor

WHO/ISUP Grades (1998)

WHO Grades (2004)

Urothelial papiloma

Urothelial neoplasm of low malignantpotential

Papillary urothelial carcinoma, low grade

Papillary urothelial carcinoma, high grade


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NRegional lymph nodes

N0no lymph node involvement

N1single lymph nodes involvement

N2, N3more lymph nodes involvement

Mdistant metastases

M0no distant metastases

M1positive distant metastases (liver, lung, bone

marrow)


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Clinical features

Painless hematuria: Painless intermittent hematuria (+groos bleeding)

Classic sign for malignancy causing bleeding.

If the malignancy occur at upper urinary tract (kidney till vesico-ureteric junction)ureteric colic and long stringy clots. Ureteric

obstruction if bleeding is gross. Lower tractblood clot in urine and acute urine retention (clot

retention).

Recurrent urinary infections

Incontinence when invading the neck (or tumor at the neck) dribbling incontinence, urge incontinence

Dysuria, frequency, urgency.

Depending on the location and severity: may have voidingsymptoms (poor stream, post micturition dribbling, hesitancy,


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URINARY BLADDER PATHOLOGY.pptx