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Bladder

Cystitis

Interstitial (Hunnerís) 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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● Definition of the European Society for the Study of Interstitial Cystitis (2008): diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom, such as persistent urge to void or urinary frequency (Med Clin North Am 2011;95:55)
● Rare idiopathic condition of edematous and possibly ulcerated bladder mucosa
● Diagnosis of exclusion
● Diagnose from clinical features since histologic features are nonspecific (Am J Surg Pathol 1990;14:969)

Terminology
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● Also called Hunnerís ulcer, painful bladder syndrome, bladder pain syndrome (by European Society for the Study of Interstitial Cystitis 2008)
● Divided into two types: classic Inflammatory (Hunner) type lesions and nonulcer disease

Epidemiology
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● Middle-aged white women

Etiology
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● Associated with shift from the normal bladder urothelial keratin phenotype to a more squamous keratin profile, although is no morphologic evidence of squamous differentiation (Am J Clin Pathol 2006;125:105)
● Postulated causes include increased urothelial permeability, immunologic or neurogenic abnormalities, pelvic floor dysfunction and even sexual abuse
● In many cases of chronic bladder pain, there are associations with irritable bowel syndrome, fibromyalgia, Sjogren syndrome, anxiety disorders and chronic pain in locations other than the bladder

Clinical features
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● Suprapubic pain related to bladder filling, accompanied by increased frequency and other symptoms, with no urinary infection or other obvious pathology
● Best diagnosed from clinical features, since histologic findings are nonspecific (Am J Surg Pathol 1990;14:969)

Treatment
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● Variable; includes behavioral modification, pharmacotherapy or endoscopic treatments

Clinical (gross) description
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● Classic inflammatory type lesions: reddened mucosal areas with small vessels radiating towards a central scar, fibrin deposit or coagulum; site may rupture with oozing of blood and can have bullous edema
● Nonulcer type: normal appearing urothelium or can have multiple glomerulations

Gross images
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Chronic interstitial cystitis

Micro description
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● May have normal histology
● May have mucosal ulceration with overlying fibrinous exudates and necrotic debris
● Lamina propria contains chronic inflammatory cells, prominent mast cells and fibrosis
● Usually no bacteria identified

Micro images
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Various images


Fig B: edema and inflammatory cells in bladder mucosa

Interstitial cystitis #1; #2; #3

Additional references
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eMedicine

End of Bladder > Cystitis > Interstitial (Hunnerís) cystitis


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