Follicular cystitis

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 11 July 2018, last major update April 2011

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Bladder[title] follicular cystitis
Cite this page: Roychowdhury, M. Follicular cystitis. website. Accessed October 16th, 2018.
Definition / general
  • Nonspecific inflammatory disease of the bladder, with lymphoid follicles in lamina propria, often with chronic cystitis
  • Also called cystitis follicularis
  • Associated with prolonged urinary tract infection secondary to bladder outlet obstruction, neurogenic or muscular dysfunction of the bladder (commonly Salmonella or other gram- infection), intravesical chemotherapy or bcg (Clin Cancer Res 2003;9:5550)
Case reports
Gross description
  • Mucosal nodularity or granularity
Microscopic (histologic) description
  • Large number of plasmacytic cells and lymphocytes with lymphoid follicles scattered within the bladder mucosa and submucosa
  • Overlying urothelium may have mild atypia
Microscopic (histologic) images

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Bladder biopsies

Follicular cystitis

Cytology description
  • 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
  • Follicular lymphoma: very rare in bladder; closely packed follicles containing small cleaved cells without nucleoli (centrocytes) and larger noncleaved 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