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Chapter: Pathology: Renal Pathology

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Urinary Bladder Pathology

Congenital anomalies of the bladder. Exstrophy of the bladder is a developmental failure of the formation of the abdominal wall and bladder which leaves the blad-der open at the body surface.

URINARY BLADDER PATHOLOGY

Congenital anomalies of the bladder. Exstrophy of the bladder is a developmental failure of the formation of the abdominal wall and bladder which leaves the blad-der open at the body surface. Urachal cyst remnants may permit drainage of urine from a newborn’s umbilicus, and may also be a cause of bladder adenocarcinoma.

Cystitis. The etiology of cystitis varies, with important causes including organ-isms, notably from fecal flora (Escherichia coli, Proteus, Klebsiella, Enterobacter); radiation cystitis (may follow radiation therapy); and chemotherapy agents such as cyclophosphamide (hemorrhagic cystitis).

Clinically, it affects females far more than males. Symptoms include frequency, urgency, dysuria, and suprapubic pain; systemic signs such as fever and malaise are uncommon. Predisposing factors include benign prostatic hypertrophy, bladder calculi, and cystocele.

Malakoplakia is a bladder inflammatory pattern associated with a defect in macro-phage function. The cause is unknown. Macrophages contain Michaelis-Gutmann bodies, laminated basophilic structures.

Urinary bladder tumors are most commonly due to transitional cell carcinoma. There is an increasing incidence of urinary bladder tumors; males are affected more than females, and peak incidence is age 40-60. Risk factors include:

         Cigarette smoking and occupational exposure to azo dye production (transi-tional cell carcinoma) (both due to 2-naphthylamine)

         Chronic bladder infection with Schistosoma haemotobium (squamous cell car-cinoma) (Africa including Egypt and the Middle East)

Bladder cancer usually presents with painless hematuria, but it may also cause dys-uria, urgency, frequency, hydronephrosis, and pyelonephritis.

Prognosis of bladder cancer depends on the tumor grade and stage. There is a high incidence of recurrence.

Precursors of invasive transitional cell carcinoma can arise from a flat or papil-lary lesion.

         Carcinoma in situ (CIS) is a high-grade lesion with cytologic atypia in the full thickness of the epithelium. It is frequently multifocal. In 50-75% of untreated cases, it progresses to invasive cancer.

         Papillary precursors to invasive carcinoma include papilloma papillary urothelial neoplasia of low malignant potential low-grade urothelial carcinoma high-grade urothelial carcinoma.

Other bladder tumors include papillomas, adenocarcinoma, and embryonal rhab-domyosarcoma.


Miscellaneous bladder conditions

         Acquired diverticuli can complicate urinary tract outlet obstruction due to benign prostatic hyperplasia or other causes.

 

         Cystocele is the term used for prolapse of the bladder into the vagina. It is common in middle-aged to elderly women.

 

         Cystitis cystica et glandularis causes formation of small cysts and glands in the bladder mucosa related to chronic inflammation. It is associated with an increased risk of adenocarcinoma.


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