Diseases of the Diseases of the Lower Urinary TractLower Urinary Tract

CSBR.Prasad, MD.,

MalakoplakiaMalakoplakia

• Chronic inflammation with defect in phagocytic or degradative function of macrophages

• E.coli, proteus• Gross: Yellowish mucosal plaques• Microscopy: – Sheets of macrophages– Michaelis-Gutmann bodies

It’s an example for FRUSTRATED PHAGOCYTOSIS

MalakoplakiaMalakoplakia::Soft, yellow,

slightly raised mucosal

plaques 3-4 cm in diameter

Clinical Importance:Mistaken for malignancy

Michaelis-Gutmann bodies

Interstitial CystitisInterstitial Cystitis[[Hunner’s ulcer]

• Painful chronic cystitis• Young woman• Clinical features:– Suprapubic pain– Urgency, dysuria– Hematuria

• Cystoscopy: Fissures & Punctate hemorrhages• Culture negative• Complication: Fibrosis with reduced bladder volume

Cystoscopy: Cystoscopy: Glomurulations

Fissures

Rertroperitoneal fibrosis

• Methylesergide• Ergot derivatives

Neoplasms of the BladderNeoplasms of the Bladder

Neoplasms of the BladderNeoplasms of the Bladder

• >95% of the tumors are of epithelial origin• Most of them are transitional cell tumors• Others: – Squamous cell Ca and – Adenocarcinomas

• High morbidity and mortality

EtiologyEtiology

• Smoking• Chemicals & Drugs– Arylamines esp. Naphathylamine– Saccharine– Analgesics– Immunosuppression: Cyclophosphamide

• Schistosoma hematobium• Radiation (pelvic malignancies)

EtiologyEtiology

Tumors of the urinary bladderUrothelial tumors (Transitional)

Inverted papillomaPapilloma - exophyticUrothelial tumor of low malignant potentialPapillary urothelial carcinomaCarcinoma in situ

Squamous cell carcinomaAdenocarcinomaMixed carcinomasSmall cell carcinomaSarcomas

Two precursor lesions

• Non-invasive papillary tumor• Flat urothelial carcinoma (ca “in situ”)

Most important histological feature that determines the prognosis

• Invasion into the muscularis propria - detrusor muscle

• With this feature 5yr mortality rate is 50%

Gross: Urothelial tumors

• Papillary• Nodular• Flat

• Invasive• Non-invasive

Four morphological patterns of bladder tumors

GrossGross: Urothelial tumors: Urothelial tumors• Papillary:– Red elevated excrescences 1-5cms– Multicentric– Most of them are low grade

• Types:– Papillomas ( < 6 cell thick)– PUNLMP (> 6 cell thick)– Low grade PU Ca (Hyperchromatic nuclei, basal mitosis)– High grade PU Ca (Porminent nucleoli, Mitotsis, anaplasia)– Ca “in situ” (cytologically malignant cells in flat urothelium)– Invasive urothelial carcinoma (lamina propria, muscle)

Cystoscopic appearances

Bladder Mass

High grade papillary urothelial carcinoma

Ca in situ

Other malignant tumorsOther malignant tumors

• Squamous cell carcinoma– Calculi– Schistosoma hematobium

• Adenocarinomas– Urachal remnants (anterior wall towards umbilicus)

• Mixed types• Small cell carcinoma

Small Cell Carcinoma of Bladder with overlying Urothelial Carcinoma-in-situ

Small Cell Carcinoma of Bladder with overlying Urothelial Carcinoma-in-situ

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