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Bladder

Cystitis

Cystitis cystica and cystitis glandularis


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 13 June 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

General
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● 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: Brunnís nests that grow into lamina propria and are transformed into urothelium lining slitlike 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

Sites
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● Occurs in trigone, also ureter and renal pelvis

Clinical features
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● 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 features
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● 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
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● 41 year old man with bladder tumor consisting of cystitis glandularis of intestinal type with mucin extravasation (Arch Pathol Lab Med 2004;128:e89)

Treatment
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● Removal of source of irritation; also long term 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
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● Irregular papillary lesions resembling papillary urothelial carcinoma

Micro images
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Cystitis cystica

   
Cystitis glandularis of common type


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

           
Cystitis glandularis of intestinal type

   
Mucin extravasation

Cytology images
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Cystitis glandularis

Stains
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● 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
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Bladder adenocarcinoma: cytologically atypical glands, frequent mitosis, desmoplasia, invasion beyond lamina propria, invasion of smooth muscle, more difficult to differentiate with small biopsies (Histopathology 2010 Sep 21 [Epub ahead of print])
Endocervicosis: glands deeply situated involving deep muscularis propria and lamina propria, often ciliated cells interspersed in the epithelial lining

End of Bladder > Cystitis > Cystitis cystica and cystitis glandularis


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