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Bladder

Cystitis

Polypoid / papillary cystitis


Reviewers: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 15 May 2011, last major update May 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Nonspecific mucosal reaction secondary to chronically inflamed bladder, with grossly noted polypoid lesions (with edema) or papillary lesions

Terminology
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● May overlap with bullous cystitis
● Analogous lesions occur throughout the urothelial tract and are referred to as polypoid urethritis, polypoid ureteritis, and polypoid pyelititis when present in the urethra, ureter, and renal pelvis respectively

Epidemiology
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● Rare, mean age 49 years, 75% male

Etiology
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● Due to injury to bladder mucosa; seen commonly in patients with indwelling catheter and vesical fistula
● Papillary cystitis is chronic phase of polypoid cystitis

Clinical features
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● Often, but not always due to bladder catheterization (Int Urol Nephrol 2002;34:293); more common/severe with frequent catheterization
● Also associated with Beckwith-Wiedemann syndrome, radiation therapy

Case reports
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● 41 year old woman with ovarian abscess (Int Urogynecol J Pelvic Floor Dysfunct 2007;18:579)

Treatment
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● Remove source of injury

Gross description (Macroscopy)
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● Friable, broad-based, often edematous bullous, polypoid or papillary lesions in dome or posterior bladder wall
● Can mimic a papillary urothelial neoplasm cystoscopically

Micro description (Histopathology)
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● Low power diagnosis must recognize reactive nature of process with inflamed background and urothelium of normal thickness (Am J Surg Pathol 2008;32:758)
● Thin, finger-like papillae or broad based polypoid lesions with congestion and edema of lamina propria
● Mild chronic inflammatory infiltrate
● May have reactive epithelial atypia or reactive fibroblasts that appear bizarre
● Covered by normal appearing or metaplastic urothelium with orderly maturation and surface umbrella cells (Am J Surg Pathol 1988;12:542)
● Fronds with fibrosis can mimic papillary urothelial neoplasms; however, the fibrovascular cores tend to be simple, non-branching and broad-based
● No hyperchromasia, no coarse chromatin, no abnormal mitotic figures

Micro images
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Papillary cystitis

       

       
Polypoid cystitis


Various images

Other images

Differential diagnosis
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Papillary urothelial neoplasms: At low power and cystoscopy, appears neoplastic and not inflammatory; prominent atypia present (papillary urothelial carcinoma is characterized by thin papillae lacking prominent inflammation, smaller papillae arising from larger papillae and stratified atypical epithelium lacking umbrella cells as opposed to broad based edematous papillary projections with prominent inflammation, lack of secondary smaller papillae and presence of umbrella cells in polypoid cystitis, Am J Surg Pathol 2008;32:758)

Additional references
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Arch Pathol Lab Med 2010;134:427

End of Bladder > Cystitis > Polypoid / papillary cystitis


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