Medical PPT/Urology

오예스좋아 2013. 2. 9. 17:10


Epithelial Metaplasia of Bladder.ppt


의대 혹은 간호대 방광 양성 종양 발표자료 입니다.

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이 내용은 방광 양성 종양 중 방광 상피 화생 입니다.


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이 내용은 Campbell Urology Chapter 80의 내용을 기반으로 한 여러 저널들의 내용입니다.

아 그리고 제가 직접 만든 PPT에용!!


방광 편평세포화생의 의미와 정상 세포와의 차이점, 그리고 다른 장기의 편평세포화생과 달리 방광 편평세포화생의 차이점에 대해서 기술되어 있습니다. 바뀐 최신의 경향이구요. 참고로 케라틴화 편평세포화생에서 p53이 결여되고 암으로의 진행 가능성이 적다는 논문이 발표된 이후의 교과서 내용이므로 비뇨기과 선생님들께도 유용한 자료가 될 것입니다.






Epithelial Metaplasia of Bladder



Metaplasia (Greek: "change in form")

- Reversible replacement of one differentiated cell type with another mature differentiated cell type

- The change from one type of cell to another may generally be a part of normal maturation process or caused by some sort of abnormal stimulus.

- In simplistic terms, it is as if the original cells are not robust enough to withstand the new environment, and so they change into another type more suited to the new environment. If the stimulus that caused metaplasia is removed or ceases, tissues return to their normal pattern of differentiation.

- Metaplasia is not synonymous with dysplasia and is not directly considered carcinogenic. It is also contrasted with heteroplasia, which is the abnormal growth of cytologic and histologic elements without a stimulus. 









Epithelial metaplasia - focal areas of transformed urothelium with normal nuclear and cellular architecture surrounded by normal urothelium usually located on the trigone 

  ① Squamous metaplasia

       - Nonkeratinizing squamous metaplasia
       - Keratinizing squamous metaplasia  = leukoplakia
  ② Glandular metaplasia



Squamous Metaplasia

Nonkeratinizing squamous metaplasia 

• Present in 85% of reproductive-age women and 75% of menopausal women in trigone where it's considered a normal (non-metaplastic) finding; occurrence outside this area is considered metaplastic.

• May cause urinary urgency/frequency (pseudomembranous trigonitis), but has no risk for progression to neoplasia.

• Also seen in male receiving hormonal therapy for prostate cancer.

• Histology: squamous cells usually have bubbly appearance due to accumulation of glycogen that produces cytoplasmic clearing




Keratinizing squamous metaplasia


•Associated with long-standing mucosal irritation, such as prolonged catheterization, lithiasis, chronically infected bladder, diverticula or schistosomiasis.
•More common in patients with spinal injury or paraplegia.
•Can be visualized as gray to white patches or plaques.
•Histology: hyperkeratotic squamous epithelium
•In the past, keratinizing squamous metaplasia of bladder was thought be associated with concurrent or subsequent carcinomas with squamous differentiation, and suggested as precursor lesion for squamous cell carcinoma.
--> but this notion is changed after publication of journal that keratinizing squamous metaplasia lacks p53 mutation.

•Cytogenetic studies on bladder keratinizing squamous metaplasia (leukoplakia) are consistent with a benign lesion, and no treatment is necessary.







Glandular Metaplasia


- Clumps of raised red areas that appear inflammatory and are often confused for cancer.

- Glandular metaplasia can extensively involve the bladder, particularly the trigone, but biopsy is not required. Treatment is unnecessary, and a preventive agent has not been identified.




 Campbell Urology

  Chapter 80 : Urothelial Tumors of the Bladder 



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