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Bladder
Cystitis
Follicular cystitis
Author: Nat Pernick, M.D. (see Authors page)
Revised: 21 December 2009, last major update - December 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Lymphoid follicles in lamina propria, often with chronic cystitis
Terminology
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● Also called cystitis follicularis, lymphofollicular cystitis
Epidemiology
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Sites
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● May be more common in trigone (Paraplegia 1995;33:565)
Etiology
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Clinical features
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● Associated with:
(a) repeated urinary tract infections, often bacterial
(b) other factors that contribute to prolongation of infection (possibly paraplegia with chronic indwelling catheters-BMC Urol 2002 Apr 30;2:5)
(c) Salmonella urinary tract infection
(d) intravesical chemotherapy (bcg, interferon-Clin Cancer Res 2003;9:5550)
● When due to bacteria, appears to disappear when patients become abacteriuric (J Urol 1990;143:330)
● May be present when there is no evidence of infection
Prognostic factors
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Case reports
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● 39 year old man with paraplegia (Cases J 2009 Aug 6;2:7333)
Treatment
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Clinical images
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Gross description (Macroscopy)
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Gross images
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Micro description (Histopathology)
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● Lymphoid follicles in lamina propria
● Overlying urothelium may have mild atypia
Micro images
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Post-interferon therapy for urothelial carcinoma:
lymphoid follicles (fig C) with immunostains: CD20-B cells; CD45RO-T cells; CD8-cytotoxic T cells
Cytology description
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● Lymphocytes plus cellular elements from germinal centers; may have cytologic atypia of urothelium due to reactive changes (Diagn Cytopathol 2002;27:205)
Cytology images
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no thumbnail: numerous lymphocytes with varying maturity
Positive stains
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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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● Cystitis with sporadic lymphocytes: no germinal centers, usually no overlying epithelial atypia
● 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)
● Tuberculosis: may resemble follicular cystitis at cystoscopy; histologically has granulomas, with or without central caseation
Additional references
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End of Bladder > Cystitis > Follicular cystitis
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