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In addition, there should be close surveillance of the upper tract for any infiltrating disease. In younger patients, it may be helpful to have early recognition of disease progression and early choice of total removal of the genitourinary system as a way of preventing progression to metastatic disease and potential death. Certainly, more studies are needed in this area. HISTOPATHOLOGY The majority of upper tract tumors are urothelial cancers. These are largely derived from transitional urothelium; squamous cell cancers and adenocarcinomas represent a small minority (Bennington et al, 1975; Vincente et al, 1995; Flanigan and Kim, 2004).

Normal Upper Tract Urothelium Whereas the bladder is of endodermal origin, the ureter and renal pelvis are derived from the mesoderm. Nevertheless, the urothelial lining of the upper urinary tract closely approximates that Anusol Rectal (Hydrocortisone Acetate Rectal Suppositories)- FDA the bladder except for the markedly reduced thickness of the muscle Anusol Rectal (Hydrocortisone Acetate Rectal Suppositories)- FDA and the abutting of the urothelium to the renal parenchyma proximally.

The epithelial layer is continuous from the level of the calyces to the distal ureter. This Anusol Rectal (Hydrocortisone Acetate Rectal Suppositories)- FDA needs further confirmation. Renal Pelvis and Calyces The walls of the calyces and the pelvis contain fibrous connective tissue and two layers of smooth muscle and are lined on their inner surfaces with transitional epithelium (Dixon and Gosling, 1982) (Figs.

Thin muscle layers originate in the minor calyces and form a spiral, helical arrangement (Fig. Ureter The ureter demonstrates two continuous thin muscle layers with a loosely spiraled internal layer and a more tightly spiraled external layer. In the lower third of the ureter, a third outer longitudinal layer is present.

All three layers merge with the three layers (inner longitudinal, middle circular, and outer longitudinal) of the bladder wall, which run longitudinally, transversely, and obliquely. Beneath the outer muscle coat is the serosa, made up of loose connective tissue and containing blood vessels and lymphatics (Hanna et al, 1976; Notley, 1978) (Figs. Abnormal Urothelium Anusol Rectal (Hydrocortisone Acetate Rectal Suppositories)- FDA and Dysplasia Several studies have suggested that UTUCs progress through histologic changes from hyperplasia to dysplasia to frank CIS in a significant proportion of patients (Heney et al, 1981; McCarron et al, 1982).

CIS may be patchy and may extend proximally to the Figure 58-1. Low-magnification view of a section through the kidney. The renal medulla ends in the pointed renal papilla. Urine empties into the Y-shaped space made up of the renal calyces (the arms of the Y) and the pelvis (the base of the Y).

Fat cells Collecting ducts Renal pelvis Transitional epithelium (urothelium) Figure 58-2. This image shows several large collecting ducts near the end of a medullary pyramid (i. The transitional epithelium of the renal pelvis is continuous with that of the ureters and bladder. More severe urothelial dysplastic changes are associated with a greater risk for tumor recurrence in oxygen bar distal ureter and bladder and a reduced prognosis.

Benign Lesions: Papillomas and von Brunn Nests Papillomas and inverted papillomas are generally considered benign lesions; however, because of their association with either synchronous or metachronous upper tract urothelial tumors (Renfer 1370 PART X Neoplasms of the Upper Urinary Tract Epithelium (transitional) Smooth muscle Connective tissue Figure 58-3.

In this specimen from the renal pelvis the connective tissue immediately Anusol Rectal (Hydrocortisone Acetate Rectal Suppositories)- FDA the epithelium is inconspicuous, obscured by a layer of smooth muscle (note elongated nuclei). Beneath the smooth muscle is loose connective tissue, including conspicuous adipocytes. Transitional epithelium and loose connective tissue that compose the mucosa of the urinary tract.

Transitional epithelium superficially resembles nonkeratinized stratified squamous epithelium, but note that the epithelial cells nearest the apical (outer) surface are not flattened but cuboidal. Transitional epithelium is a stratified epithelium characterized by the fact that the most apical cells are the roundest and largest in diameter.

It is journal of engineering science and technology review to be able to increase its surface area as the lumen is dilated by urine. Similarly, these findings suggest that close surveillance of the upper tracts for malignancy is warranted when inverted papilloma is diagnosed.

A B Figure 58-4. A and B, Anusol Rectal (Hydrocortisone Acetate Rectal Suppositories)- FDA section of ureter. The ureter has an irregular lumen, which is lined by transitional epithelium.



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