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Bladder

Cystitis

Follicular 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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● Non-specific inflammatory disease of the bladder, with lymphoid follicles in lamina propria, often with chronic cystitis

Terminology
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● Also called cystitis follicularis

Sites
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● Trigone is the most common site (Paraplegia 1995;33:565)

Etiology
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● Associated with prolonged urinary tract infection secondary to bladder outlet obstruction, neurogenic or muscular dysfunction of the bladder (commonly Salmonella or other gram-negative infection), intravesical chemotherapy or bcg (Clin Cancer Res 2003;9:5550)

Case reports
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● 70 year old woman with follicular cystitis (Arch Esp Urol 2007;60:77)

Gross description
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● Mucosal nodularity or granularity

Micro description
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● Large number of plasmacytic cells and lymphocytes with lymphoid follicles scattered within the bladder mucosa and submucosa
● Overlying urothelium may have mild atypia

Micro images
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Bladder biopsies

   
Follicular cystitis

Cytology
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● Reactive epithelial cells (suggested by nuclear pleomorphism without alteration of nuclear/cytoplasmic ratio and glandular metaplasia including cystitis cystica and glandularis) mixed with tissue fragments and cellular aggregates reflecting the structure of lymphoid follicles with a pleomorphic lymphoid population, intermixed histiocytes and scattered tingible body macrophages (Diagn Cytopathol 2002;27:205)

Cytology images
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numerous lymphocytes with varying maturity

Differential diagnosis
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● Follicular lymphoma: very rare in bladder; closely packed follicles containing small cleaved cells without nucleoli (centrocytes) and larger non-cleaved cells with moderate cytoplasm, open chromatin and multiple nucleoli (centroblasts); minimal or no apoptotic cells or tingible body macrophages; bcl2+ within follicles, usually t(14;18)(q32;q21)
● Other Non-Hodgkin lymphoma: monomorphic atypical lymphoid population
● Granulomatous process in cases with histiocyte predominance (low number of lymphocytes)
● Cystitis with sporadic lymphocytes: no germinal centers, usually no overlying epithelial atypia
● Tuberculosis: may resemble follicular cystitis at cystoscopy; histologically has granulomas, with or without central caseation

End of Bladder > Cystitis > Follicular cystitis

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