Ebook Atlas of adult autopsy pathology: Part 2
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Ebook Atlas of adult autopsy pathology: Part 2
I Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2ese organs are common, are often encountered at autopsy, and frequently have relevance to the cause of death. Consequently, the genitourinary tract should be examined in every autopsy.Urinary TractThe urinary tract comprises the kidneys, ureters, and bladder. Diseases of these organs are common, and Ebook Atlas of adult autopsy pathology: Part 2 they may be congenital or acquired.Congenital abnormalities of the kidneys and ureters are not infrequently encountered at autopsy and arise as a resEbook Atlas of adult autopsy pathology: Part 2
ult of errors in organogenesis. Horseshoe kidney, congenital absence of a kidney, pelvic kidney, and duplex ureters are frequently encountered abnormaI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2 limited range of responses to pathological insult, and consequently histopathological, immunological. and electron microscopic examination may be required to elucidate the underlying cause. Benign neoplasia is fairly uncommon, but malignancy is often encountered, and it may be an unexpected finding Ebook Atlas of adult autopsy pathology: Part 2 at autopsy. Renal cell carcinomas metastasize to bones, and the finding of a renal cell carcinoma should prompt examination of the vertebral bone marEbook Atlas of adult autopsy pathology: Part 2
row for the presence of metastatic disease. This is done by performing a simple vertebral strip.Disease of the ureters most typically arises as a consI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2e of more distal urinary tract obstruction. Ureteric malignant diseases are rare.The appearance of the normal bladder varies considerably, depending on the volume of urine within it. The bladder is a common site of infection, and this can result in fatal sepsis. Trabeculation and the formation of di Ebook Atlas of adult autopsy pathology: Part 2verticula are commonly encountered, particularly in men. as a result of bladder outflow obstruction, typically secondary to benign prostatic hyperplasEbook Atlas of adult autopsy pathology: Part 2
ia. Bladder calculi, once common, are now rarely encountered at autopsy. The decline in bladder calculi is multifactorial and is partly the result of I Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2 common. In the West, these are typically transitional cell carcinomas, but in those parts of the world where schistosomiasis is endemic, squamous cell carcinomas predominate.149Male Genital TractThe male genital tract includes the prostate, seminal vesicles, penis, testes, and scrotum. It should be Ebook Atlas of adult autopsy pathology: Part 2 examined in every autopsy examination.Atlas of Adult Autopsy PathologyGiven that most autopsies are performed on older adults, the normal prostate isEbook Atlas of adult autopsy pathology: Part 2
not commonly encountered. Prostatic enlargement resulting from hyperplasia is common, and the incidence increases with increasing age. The prostate iI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2iably detect prostate cancer macroscopically, and if there is clinical suspicion histopathological examination is required. The incidence of prostate cancer increases with age. but many men with prostate cancer will die with their disease rather than of it. Prostate cancers have a predilection for m Ebook Atlas of adult autopsy pathology: Part 2etastasizing to bones (where they typically produce osteosclerotic metastases). The vertebral bone marrow should be examined for the presence of metasEbook Atlas of adult autopsy pathology: Part 2
tases in any individual with a history of prostate cancer.The testes should be examined in every autopsy for evidence of trauma, infection, and malignI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2tic disease of unknown origin. Blunt trauma to the scrotum rarely causes bruising of the skin (being pliable) but often causes bruising to the firm testis. Postmortem drying artifact of the scrotum should not be confused with injury.Disease of the male urethra is uncommon. The urethra can suffer tra Ebook Atlas of adult autopsy pathology: Part 2umatic rupture either from a fall astride a hard object or as a consequence of traumatic decatheterization. Ute autopsy pathologist should be familiarEbook Atlas of adult autopsy pathology: Part 2
with techniques needed to dissect out the penile urethra in continuity with the remainder of the urinary tract, but this is not necessary in all caseI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2 genital structures are discussed in Chapter 1, but the breasts are included here. All these structures may have different appearances at different stages of life (prepubertal stage, puberty, pregnancy, maturity, and after menopause). During the reproductive years, the cyclical nature of the menstru Ebook Atlas of adult autopsy pathology: Part 2al cycle gives rise to different appearances, particularly of the uterus and ovaries. Pregnancy also causes identifiable changes.The diseases that ariEbook Atlas of adult autopsy pathology: Part 2
se in the reproductive years are often very different from those of the postmenopausal years, and pregnancy itself is associated with many disorders tI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2be immediately apparent or an occult primary tumor in a case of metastatic carcinoma of unknown origin. Similarly, the breasts should be examined for evidence of previous surgery, radiation therapy, or active tumors.Examination of the breasts and genital tract should also look for injuries. Although Ebook Atlas of adult autopsy pathology: Part 2 injuries to the vagina or breasts are in no way diagnostic of sexual assault (and, indeed, the absence of genital injury does not exclude nonconsensuEbook Atlas of adult autopsy pathology: Part 2
al intercourse), any injuries should always be considered in the overall context of the case, and if any concerns exist, a senior colleague or forensiI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2postmenopausal years. Deaths that appear to be associated with pregnancy or the postpartum period (so-called maternal deaths) present their own unique challenges, and the autopsy should be undertaken by a pathologist experienced in such deaths or with the assistance of such an individual.The Genitou Ebook Atlas of adult autopsy pathology: Part 2rinary SystemAnatomical variants may be encountered, particularly of the uterus, such as bicornuate, Sep late, unicornuale, and didelphic uterus. BicoEbook Atlas of adult autopsy pathology: Part 2
rnuate uteri are described as “heart shaped. ’ where the upper uterine body is formed by two horns. Septate uterus describes a uterus in which the uteI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2terus with two separate cervices, and often a double vagina as well, Ihese variants rarely have direct relevance to death, but documentation of such anomalies is best practice for the thorough autopsy pathologist.The pathologist should record the presence or absence ol the pelvic organs (hysterectom Ebook Atlas of adult autopsy pathology: Part 2y with or without salpingo-oophorectomy is a relatively common procedure), along with whether the organs appear atrophic (as is often the case in oldeEbook Atlas of adult autopsy pathology: Part 2
r patients), and the presence of any lesions such as fibroids, cysts, or polyps should be recorded. The author lends to refer to benign, well circumscI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2osed lesions.Kidney4 Figure 7.1 Normal kidneyThe normal kidney lies encased within fat. the thickness of which depends on the deceased's body habftus. A shallow incision into the lateral border allows the capsule to be easily lifted, revealing a smooth, shiny, dark red-brown cortical surface. The au Ebook Atlas of adult autopsy pathology: Part 2thor places no significance on the presence of an adherent capsule in an otherwise normal kidney. Fetal lobations may be evident but are normal. SliciEbook Atlas of adult autopsy pathology: Part 2
ng the kidney with a long-bladed knife from the lateral border toward the hilum in the coronal plane reveals the cortex, medulla, and renal pelvis. ThI Chapter 7The Genitourinary SystemIntroductionThe genitourinary tract comprises the kidneys, ureters, bladder, and the sexual organs. Diseases of the Ebook Atlas of adult autopsy pathology: Part 2ortex, and becoming paler toward the renal pelvis as a result of the formation by the collecting ducts of visible pale medullary rays.151<4 Figure 7.2 Pale kidneysIn patients who have exsanguinated, the kidneys are pale, a change Hull first aliecls the cortex and then the medullary pyramids. Such re Ebook Atlas of adult autopsy pathology: Part 2nal pallor should prompt a search for the cause of the blood loss.Atlas of Adult Autopsy Pathology152•d Figure 7.3 Horseshoe kidneyGọi ngay
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