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Luti Luti Presentation Transcript

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