Bladder
Cystitis
Polypoid / papillary cystitis

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

Revised: 31 May 2016, last major update May 2011

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Polypoid papillary cystitis
Cite this page: Polypoid / papillary cystitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderpolypoidcystitis.html. Accessed December 6th, 2016.
Definition / General
  • Nonspecific mucosal reaction secondary to chronically inflamed bladder, with grossly noted polypoid lesions (with edema) or papillary lesions
Terminology
  • 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
  • Rare, mean age 49 years, 75% male
Etiology
  • 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
  • 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
Treatment
  • Remove source of injury
Gross Description
  • 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
  • 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

Images hosted on other servers:

Papillary cystitis


Polypoid cystitis

Differential Diagnosis
  • 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