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Bladder

Cystitis

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.

Definition
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● 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

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

Treatment
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● 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
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Intraoperative photograph shows mass (arrow) protruding into the lumen

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

Micro description
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● 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
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Eosinophilic cystitis due to schistosomiasis (egg not visible)

   
Intense infiltration of eosinophils deep within the muscularis propria


Dense inflammatory infiltrate

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

End of Bladder > Cystitis > Eosinophilic cystitis

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