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Eosinophilic cystitis

Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 23 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.


● Inflammatory condition of the urinary bladder, with recurrent episodes of urinary frequency, dysuria, gross hematuria and suprapubic pain during micturition
● Not related to Langerhans cell granulomatosis


● Rare (about 200 reported cases)
● Women or children with allergic disorders and peripheral eosinophilia, older men with prostate/bladder disorders, or parasitic infestation

Clinical features

● Reported at all ages with striking predominance in females
● 20% occur in children; symptoms tend to disappear spontaneously (Arch Dis Child 2001;84:344)
● Clinical and imaging findings are nonspecific; cystoscopic findings include ulcers, exudates, edematous bullae or polyps (which may simuate malignancy)

Case reports

● Case series in males (Arch Pathol Lab Med 2009;133:289)
● Eosinophilic cystitis associated with eosinophilic enterocolitis (Br J Radiol 2010;83:e122)


● Treatments are typically not curative
● Withdrawal of any identifiable precipitating factor
● Nonsteroidal anti-inflammatory agents and anti-histamines are favored first-line agents followed by corticosteroids or cyclosporine
● Transurethral resection is used in refractory cases (J Urol 2001;165:805)
● Long-term follow-up is recommended for all patients (Int J Clin Pract 2005;59:356)

Clinical images

Intraoperative photograph shows mass (arrow) protruding into the lumen

Gross description

● Edematous and erythematous mucosa with polypoid growths resembling allergic polyps of nasal septum

Micro description

● Hispathological findgings can be divided in “acute” and “chronic” phase:
● Acute phase: prominent eosinophilic infiltrate (Yamada and Taguchi criteria are 20 or more eosinophils per five 20x fields) with edema and occasional muscle necrosis; Charcot-Leyden crystals may be present (Arch Pathol Lab Med 2009;133:289)
● Chronic phase: fewer eosinophils, but more prominent mast cells, plasma cells and muscle fibrosis

Micro images

Eosinophilic cystitis due to schistosomiasis (egg not visible)

Intense infiltration of eosinophils deep within the muscularis propria

Dense inflammatory infiltrate

Additional references

Arch Pathol Lab Med 1984;108:728, Am J Clin Pathol 1979;72:777

End of Bladder > Cystitis > Eosinophilic cystitis

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