Bladder & ureters
Cystitis cystica and cystitis glandularis

Topic Completed: 1 October 2015

Revised: 31 March 2020

Copyright: 2003-2019,, Inc.

PubMed Search: cystitis cystica glandularis

Monika Roychowdhury, M.D.
Page views in 2019: 19,270
Page views in 2020 to date: 4,999
Cite this page: Roychowdhury M. Cystitis cystica and cystitis glandularis. website. Accessed April 7th, 2020.
Definition / general
  • Common incidental findings
  • Referred to together as cystitis cystica et glandularis
  • Associated with longstanding chronic cystitis, bladder exstrophy, ureteral reimplantation, neurogenic bladder or other causes of mucosal irritation

  • Cystitis cystica: Brunn nests that grow into lamina propria and are transformed into urothelium lining slit-like or cystic spaces with pink fluid; present in up to 60% of bladders
  • Cystitis glandularis of common type: glands in lamina propria lined by columnar or cuboidal epithelium; more common than intestinal type in most series but see Indian J Pathol Microbiol 2009;52:203
  • Cystitis glandularis of intestinal type: also called intestinal metaplasia, colonic metaplasia; usually in bladder neck and trigone; may present as papillary or polypoid mass; has goblet cells that resemble colonic epithelium
  • Cystitis glandularis of intestinal type is usually confined to lamina propria, may have mucin extravasation with dissecting mucin pools and be misdiagnosed as adenocarcinoma but no significant atypia, no glandular disarray, no desmoplasia, no muscular invasion, no signet ring cells, no necrosis, no / minimal mitotic activity, no carcinoma in situ, no single cells floating in mucin (Am J Surg Pathol 1996;20:1462)
  • Patients with extensive intestinal metaplasia have higher risk for adenocarcinoma

Inflammation of ureters:
  • Associated with long standing chronic inflammation, similar to processes seen in the urinary bladder
  • Ureteritis cystica: fine cysts in mucosa composed of dilated von Brunn nests (lined by normal urothelium) with clear contents
  • Ureteritis follicularis: fine granular mucosa due to multiple lymphoid follicles
  • Ureteritis glandularis: usual type includes formation of cystic spaces similar to ureteritis cystica but with apical (glandular) orientation of the cytoplasm surrounding the lumen
  • Intestinal metaplasia: (or ureteritis glandularis intestinal type) includes true mucin producing goblet cells (risk of developing carcinoma has been proposed although controversial)
  • Granuloma inguinale: case report of extragenital granuloma inguinale presenting as a retroperitoneal mass resembling a soft tissue neoplasm and involving the ureter (Hum Pathol 1990;21:559)
  • Occurs in trigone, also ureter and renal pelvis
Clinical features
  • Usually asymptomatic, may cause recurrent urinary tract infections; often benign incidental findings in biopsies done for other reasons
  • May occasionally appear as nodular, irregular mass on cystoscopic examination
Prognostic factors
  • Cases of widespread cystitis glandularis progressing to adenocarcinoma have occurred
  • Presence of nuclear beta catenin is suggestive of malignant potential, in contrast to cystitis glandularis of usual type which expresses membranous beta catenin (J Urol 2003;170:1892)
Case reports
  • Removal of source of irritation; also longterm antibiotic therapy for chronic urinary tract infections or transurethral resection of cystitis glandularis tissue
  • Surgical options reserved for patients who do not respond to conservative therapies
Gross description
  • Irregular papillary lesions resembling papillary urothelial carcinoma
Gross images

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Cystitis glandularis of common type, mixed with cystitis glandularis of intestinal type

Microscopic (histologic) images

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Cystitis cystica

Cystitis glandularis of common type

Cystitis glandularis of intestinal type

Mucin extravasation

Contributed by Dr. Semir Vranić

Ureteritis cystica

Cytology images

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Cystitis glandularis

Positive stains
  • CK7+, CDX2 / CK20- in cystitis glandularis of usual type
  • CDX2 / CK20+, CK7- in cystitis glandularis of intestinal type
  • Neuroendocrine markers focally; PSA, PAP in some cases (Arch Pathol Lab Med 1988;112:734)
Differential diagnosis
  • Bladder adenocarcinoma: cytologically atypical glands, frequent mitosis, desmoplasia, invasion beyond lamina propria, invasion of smooth muscle, more difficult to differentiate with small biopsies (Histopathology 2011;58:811)
  • Endocervicosis: glands deeply situated involving deep muscularis propria and lamina propria, often ciliated cells interspersed in the epithelial lining
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