Luti

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Luti

  1. 1. LOWER URINARY TRACT INFECTION, CYSTITIS, AND URETHRITIS Sarawut Kongkarnka, MD, FRCPath Department of Pathology Faculty of Medicine Chiang Mai University
  2. 3. URETERITIS <ul><li>One component of lower urinary tract infections </li></ul><ul><li>Entirely non-specific morphologic changes </li></ul><ul><li>Chronic ureteritis - Persistence of infection - Repeated acute exacerbations </li></ul>
  3. 4. URETERITIS <ul><li>Specialized reaction patterns: - Ureteritis follicularis - Ureteritis cystica </li></ul>Ureteritis cystica. Note the smooth cysts projecting from the mucosa. http://library.med.utah.edu/WebPath/jpeg1/RENAL148.jpg
  4. 5. CYSTITIS <ul><li>Bacterial pyelonephritis frequently preceded by infection of urinary bladder </li></ul><ul><li>Common agents are coliforms: Escherichia coli Proteus Klebsiella Enterobacter </li></ul><ul><li>Women > Men: Shorter urethras </li></ul>
  5. 6. CYSTITIS <ul><li>Tuberculous cystitis </li></ul><ul><li>Candidal cystitis, Cryptococcal cystitis </li></ul><ul><li>Schistosomiasis </li></ul><ul><li>Virus, Chlamydia, Mycoplasma </li></ul><ul><li>Hemorrhagic cystitis: Cyclophosphamide </li></ul><ul><li>Radiation cystitis </li></ul><ul><li>Predisposing factors: Bladder calculi, bladder obstruction, DM, instrumentation, or immune deficiency </li></ul>
  6. 7. http :// www . drrajmd . com / conditions / bladder / cystitis / cystits / 19094 . jpg
  7. 8. Schistosoma life cycle. http :// www . newplague . org / Schistomes_LifeCycle . gif
  8. 9. CYSTITIS <ul><li>Triad of symptoms - Frequency: every 15-20 minutes - Lower abdominal pain - Dysuria: pain or burning on urination </li></ul>Acute cystitis. Hyperemia of the mucosa, sometimes associated with exudate.
  9. 10. CYSTITIS <ul><li>Hemorrhagic cystitis: Bleomycin </li></ul><ul><li>Suppurative cystitis </li></ul><ul><li>Ulcerative cystitis </li></ul><ul><li>Chronic cystitis </li></ul><ul><li>Follicular cystitis: DDx from lymphoma </li></ul><ul><li>Eosinophilic cystitis </li></ul>
  10. 11. SPECIAL FORMS OF CYSTITIS <ul><li>Interstitial cystitis (Hunner cystitis) Persistent, painful, form of chronic cystitis occurring most frequently in women and associated with inflammation and fibrosis of all layers of the bladder wall </li></ul><ul><li>Clinical Constellation of symptoms </li></ul><ul><li>Cystoscopic findings: fissures and punctate hemorrhages in mucosa </li></ul><ul><li>Hunner ulcers </li></ul>
  11. 12. Interstitial cystitis. http://www.health.harvard.edu/newsweek/images/cystitis2.jpg
  12. 13. Interstitial cystitis. http://www.smithinstituteforurology.com/images/patient_pelvic_hydrodistention_img_1.jpg
  13. 14. Interstitial cystitis. http://www.icaction.com/images/bladder_before.jpg
  14. 15. Interstitial cystitis. http://www.smithinstituteforurology.com/images/patient_pelvic_lesions_img_1.jpg
  15. 16. INTERSTITIAL CYSTITIS <ul><li>Early stage (nonclassic, nonulcerative) </li></ul><ul><li>Late stage (classic, ulcerative) </li></ul><ul><li>Biopsy Roles - Specific diagnosis - Rule out flat carcinoma in situ </li></ul><ul><li>Autoimmune origin Associate with SLE, Sj Ö gren syndrome </li></ul><ul><li>Incurable, palliative treatment for relief </li></ul>
  16. 17. MALACOPLAKIA <ul><li>Gross: soft yellow, slightly raised mucosal plaques, 3-4 cm in diameter </li></ul><ul><li>Micro: infiltration with large, foamy histiocytes with occasional multinucleate giant cells and interspersed lymphocytes </li></ul><ul><li>Von Hansemann macrophages: abundant granular cytoplasm (PAS +) </li></ul><ul><li>Michaelis-Gutmann bodies </li></ul>
  17. 18. Cystitis with malacoplakia.
  18. 19. Malacoplakia (H&E stain)
  19. 20. Malacoplakia (PAS stain)
  20. 21. MALACOPLAKIA <ul><li>Colon, lung, bone, kidney, prostate, and epididymis </li></ul><ul><li>Chronic bacterial infection: E. coli </li></ul><ul><li>Immunocompromised host </li></ul><ul><li>Defect in phagocytic or degradative functions of macrophages </li></ul><ul><li>DDx: - Langerhans cell histiocytosis - Xanthogranulomatous inflammation </li></ul>
  21. 22. POLYPOID CYSTITIS <ul><li>Irritation to the bladder mucosa resulting in a polypoid configuration </li></ul><ul><li>Urothelium: broad, bulbous, polypoid projection </li></ul><ul><li>Benign course </li></ul><ul><li>Both genders equally </li></ul><ul><li>DDx: Papillary urothelial cell carcinoma </li></ul>
  22. 23. Polypoid cystitis.
  23. 24. POLYPOID CYSTITIS <ul><li>Polypoid cystitis Broad-based, thick papillae with marked edema </li></ul><ul><li>Bullous cystitis Papillae with extensive edema such that width is greater than height </li></ul><ul><li>Papillary cystitis End stage with slender finger-like papillae with more fibrosis </li></ul>
  24. 25. METAPLASTIC LESIONS <ul><li>Brunn nest grow downward into lamina propria </li></ul><ul><li>Cystitis cystica: lined by urothelium </li></ul><ul><li>Cystitis glandularis: lined by cuboidal or columnar epithelium </li></ul><ul><li>Cystitis cystica et glandularis </li></ul><ul><li>Not associate with adenocarcinoma </li></ul>
  25. 26. Cystitis cystica and Cystitis glandularis
  26. 27. Cystitis cystica
  27. 28. Cystitis glandularis
  28. 29. URETHRITIS <ul><li>Gonococcal and non-gonococcal urethritis </li></ul><ul><li>Often accompanied by cystitis (women) and prostatitis (men) </li></ul><ul><li>Chlamydia (e.g. C. trachomatis) </li></ul><ul><li>Ureaplasma urealyticum </li></ul><ul><li>Reiter syndrome: Triad of arthritis, conjunctivitis, and urethritis </li></ul><ul><li>Local pain, itching, and frequency </li></ul>
  29. 30. THANKS FOR YOUR ATTENTION

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