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Bladder
Cystitis
Cystitis cystica and cystitis glandularis
Author: Nat Pernick, M.D. (see Authors page)
Revised: 17 December 2009, last major update - December 2009, UPDATE IN PROGRESS
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Common incidental finding (60% of bladders) in which Brunn’s nests grow into lamina propria and are transformed into urothelium lining slitlike or cystic spaces with pink fluid
Terminology
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● Also called cystitis cystica et glandularis
Epidemiology
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●
Sites
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● In trigone, also ureter and renal pelvis
● Intestinal type is often in bladder neck and trigone
Etiology
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● Associated with longstanding chronic cystitis, bladder exstrophy, ureteral reimplantation, neurogenic bladder or other causes of mucosal irritation
● May regress if cause of bladder irritation is removed
Clinical features
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● May present as papillary or polypoid mass
● Patients with extensive cystitis cystica et glandularis or intestinal metaplasia may have concurrent adenocarcinoma, but no higher risk for subsequent carcinoma (Urology 2008;71:915)
● Rarely arises in children (BJU Int 2005;95:411)
Prognostic factors
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●
Case reports
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● 32 year old woman with bladder mass (Nat Clin Pract Urol 2007;4:341)
● 41 year old man with bladder tumor consisting of cystitis glandularis of intestinal type with mucin extravasation (Archives 2004;128:e89)
● 42 year old man with microscopic hematuria (University of Oklahoma)
● 46 year old man with bladder mass (J Nippon Med Sch 2008;75:347)
● 47 year old man with AIDS and severe disease requiring cytoprostatectomy (Clinics (Sao Paulo) 2008;63:713)
● 49 year old woman with recurrent gross hematuria and non-papillary tumor (Indian J Urol 2008;24:558)
Treatment
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● No treatment required (but see case report in AIDS patient above); may regress if cause of bladder irritation is removed
Clinical images
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Cystoscopy shows blueberry spots, link
Cystoscopy shows cobblestone appearance of the mucosa with a focal polypoid mass (arrow), link
Gross description (Macroscopy)
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● Irregular papillary lesion resembling papillary urothelial carcinoma
Gross images
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Micro description (Histopathology)
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● Either common type or intestinal type
● Cystitis glandularis of common type: glands in lamina propria lined by columnar or cuboidal epithelium, more common than intestinal type; “glands” are layers of basal and intermediate urothelium lined by superficial urothelium, compressed into a columnar shape; cysts are due to obstruction of pores of Brunn’s nests
● Cystitis glandularis of intestinal type: also called intestinal metaplasia or colonic metaplasia; has goblet cells present in cystitis cystica that resemble colonic epithelium
● Intestinal type is often in bladder neck and trigone, may present as papillary or polypoid mass, 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
● Patients with extensive intestinal metaplasia have higher risk for adenocarcinoma
Micro images
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Cystitis cystica and glandularis of common type
FLORID CYSTITIS GLANDULARIS (Courtesy of Dr. Brian Montgomery, Fairhope, AL.)
Cystitis glandularis of intestinal type
Polypoid cystitis cystica et glandularis, intestinal type. link
Surface goblet cells in association with glandular distention of Brunn’s nests
Intestinal metaplasia replacing urothelium
Extensive colonic (intestinal) metaplasia
Mixed common and intestinal type, #1
Nests of von Brunn with cystic changes (straight arrow), typical of cystitis cystica, and mucin-filled goblet cell metaplasia (curved arrow), typical of cystitis glandularis, link
Cystitis glandularis of intestinal type with mucin extravasation
Cystitis glandularis of intestinal type
Various immunostains, link
Cytology description
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●
Cytology images
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Cystitis glandularis
Positive stains
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● The immunoprofile differs for typical cystitis glandularis (CK7+, CK20-) than intestinal metaplasia (CDX2+, CK20+, CK7-, Mod Pathol 2006;19:1395)
● Neuroendocrine markers are focally positive
● PSA (Archives 1988;112:734) and PAP in some cases
Negative stains
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●
Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Nested variant of urothelial carcinoma: resembles florid von Brunn’s nests, but von Brunn’s nests may also arise in ureter or pelvis, are noninfiltrative, and have lower Ki-67 index (Am J Surg Pathol 2003;27:1243)
● Adenocarcinoma: may resemble cases with mucin extravasation (AJSP 1996;20:1462)
Additional references
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End of Bladder > Cystitis > Cystitis cystica and cystitis glandularis
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