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Bladder

Cystitis

Granulomatous cystitis

Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 24 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Granulomas in bladder, due to various infectious or treatment related causes

Etiology
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● Tuberculosis, bCG (bacillus Calmette-Guerin) treatment for papillary urothelial carcinoma, biopsy / resection, Schistosoma haematobium infection, actinomycosis

Clinical features
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● Tuberculosis: rare in most countries; bladder lesions near trigone, smaller lesions merge over time into large ulcers; may involve prostate or vagina; often secondary infection from kidney
● bCG: used to treat high grade papillary carcinoma or carcinoma in situ of bladder
● Post-biopsy / resection: present in 14% with 2 surgical procedures

Case reports
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● Primary vesical actinomycosis (Int J Urol 2007;14:969)

Treatment
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● Possibly bladder botulinum toxin A injection to increase bladder capacity (BJU Int 2008;102:704)

Gross description
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● Can present as mass/polypoid lesion

Micro description
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● Tuberculosis: caseating granulomas with Langerhans giant cells, mostly in lamina propria with mucosal ulceration
● bCG: induces chronic inflammation, superficial ulceration and noncaseating granulomas with active and chronic inflammation; changes may extend into prostate (Am J Clin Pathol 1993;99:244)
● Post-biopsy / resection: either necrotizing and palisading, resembling rheumatoid nodules, or foreign body type (without foreign material) or both (Am J Clin Pathol 1986;86:430)
● Actinomycosis: scattered lymphoid follicles and non-specific inflammation with or without intermixed colonies of Actinomyces

Micro images
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Due to bCG treatment


Post-resection

End of Bladder > Cystitis > Granulomatous cystitis

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