Pathology Of Bladder

Normal histo: mucosa is transitional epithelium, 7 layers in thickness (somewhat thicker than mucosa of the ureter), lamina propria, muscularis mucosae, adventitia. As you can see, this description is almost identical to the one above for the ureter.

Cystocele is relaxation of pelvic support, common in women, which causes prolapse of the uterus. As a result, part of the bladder protrudes into vagina (if you look at Netter, it makes much more sense). So, a woman with cystocele will have trouble emptying bladder (that part of the bladder “sitting” in vagina will have trouble emptying).

1. Congenital anomalies:

   1. Diverticulus, a pouchlike eversion of the bladder wall (congenital or acquired. This can occur secondary to urethral obstruction.) This puts one at risk for infections, due to stasis of urine, and even for developing malignancy.

   2. Extrophy, developmental failure of abdominal wall and of bladder ball. Basically, you can see bladder sticking our on the external surface. This puts one at risk for infections, ulceration, and eventual malignancy.

   3. Hypoplasia

   4. Fistula, where bladder would have communication with rectum or uterus (vesecouterine fistula)

2. Inflammation = cystitis (acute and chronic)

Occurs more often in females because urethra is shorter. Causes are the same gram negative bacilli residing in our gut: E. coli, Proteus, Klebsiella. These can cause retrograde infection into ureter, kidney, etc.

Non-infections causes of cystitis: drugs and radiation

1. hemorrhagic cystitis, see blood, could be caused by radiation injury or by adenoviral infection (Robins, 6^th edition)

2. supprative cystitis: accumulation of pus

3. ulcerative cystitis: no mucosa

4. cystitis follicularis: lymphoid aggregates under bladder mucosa

clinical presentation: frequency, urgency, pain, fever, chills

5. Interstitual cystitis (Hunner Ulcer): more common in females. This is a chronic inflammatory cystitis, resulting in fibrosis (granulation tissue) of all cell layers of the bladder. This disease may be of autoimmune origin.

6. Malacoplakia: this refers to a particular inflammatory reaction. Grossly, we would see mucosall yellow plaques on the bladder. Histo: large macrophages, called Hansemann cells, with granular cytoplasm (Michaelis-Gutmann bodies)

7. Cystitis Cystica: formation of cysts, entrapment of surface epithelial cells beneath mucosa (i.e., in lamina propria).

3. Tumors

Benign:

Papilloma: fibrovascular core, covered by transitional epithelium, ~7 layers in thickness

Leiomyoma: benign tumor of smooth m, of mesenchymal origin.

Malignant: these are more common than benign.

Papillary transitional cell carcinoma, which is more frequent in males, in 5-6^th decade, sometimes associated with Shistosoma Haematobium infection, particularly in developing countries. It has a fibrovascular core, which is covered by more than 7 layers of transitional cell epithelium.

These tumors, just like all other tumors, are graded, 1-4. 1 is benign, pretty differentiated, a few cell layers thick, ~7. Grade 4 would be very poorly differentiated, with all characteristics of malignant cells, many cells layers in thickness.

Risk factors:

1. Exposure to aniline dies

2. Dietary nitrates, nitrites

3. Tobacco

Papillary transitional cell carcinoma is associated with abnormality in chromosome 9.

Clincal presentation: painless hematuria. One would have to order urine cytology and look for malignant cells. Remember: hematuria in an elderly person is cancer until proven otherwise.

Rhabdomyosarcoma, must differentiate from cells with pluripotential capabilities. There are actually 2 variants:

1. adult rhabdomyosarcoma

2. embryonal rhabdomyosarcoma, or sarcoma botryoides, which looks like a cluster of grapes.

Category: Pathology Notes