Home Chapter Home Jobs Conferences Fellowships Books
Bladder
Cystitis
Radiation cystitis
Author: Nat Pernick, M.D. (see Authors page)
Revised: 24 December 2009, last major update - December 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
=========================================================================
● Acute or chronic histologic changes associated with radiation therapy
Terminology
=========================================================================
●
Epidemiology
=========================================================================
●
Sites
=========================================================================
●
Etiology
=========================================================================
●
Clinical features
=========================================================================
● Histologic and clinical changes are time and dose dependent
● Toxicity enhanced if radiation is given with cyclophosphamide
● Similar changes with intravesical chemotherapy, which often affects superficial layer of urothelium and causes denuding cystitis
● Need high threshold for diagnosis of carcinoma after radiation and chemotherapy
● If uncertain of diagnosis, do repeat cystoscopy and biopsy after inflammation subsides
Prognostic factors
=========================================================================
●
Case reports
=========================================================================
● 71 year old man with radiation therapy for prostate carcinoma (Arch Pathol Lab Med 2005;129:1067)
Treatment
=========================================================================
● Severe hemorrhage is treated with topical application of formalin-soaked pledgets (Asian J Surg 2002;25:232), argon-beam coagulator (BJU Int. 2006;98:610), possibly recombinant activated factor VII (Ir J Med Sci 2009 Apr 8 [Epub ahead of print])
Clinical images
=========================================================================
Gross description (Macroscopy)
=========================================================================
●
Gross images
=========================================================================
Micro description (Histopathology)
=========================================================================
● Hemorrhage and hemosiderin, fibrin deposition, acute and chronic inflammation, edema and thickened mucosal folds, vascular ectasia, swollen endothelial cells, microvessel thrombi, atypical fibroblasts
● Degenerative type epithelial changes resembling carcinoma in situ but more bizarre including cytoplasmic ballooning, smudged chromatin, nuclear and cytoplasmic vacuoles, karyorrhectic cellular debris
● May have pseudoinvasive urothelial nests wrapping around the vessels associated with fibrin deposition (Am J Surg Pathol 2004;28:909)
● Late changes are blood vessels with myointimal proliferation and hyalinization, scattered atypical fibroblasts, intramural fibrosis with replacement of smooth muscle by collagen
Micro images
=========================================================================
Fig 1: dilated vascular spaces, hemorrhage, acute inflammation, fibrinous exudate and focal fibrosis in the lamina propria
Fig 2/3: rounded and irregular tufts of bland urothelium without mitotic activity, with foci conveying an invasive appearance
Fig 4: Some areas showed urothelium surrounding dilated blood vessels, which contained fibrinous deposits
Cytology description
=========================================================================
●
Cytology images
=========================================================================
●
Positive stains
=========================================================================
●
Negative stains
=========================================================================
●
Electron microscopy descriptions
=========================================================================
●
Electron microscopy images
=========================================================================
Molecular / cytogenetics description
=========================================================================
●
Molecular / cytogenetics images
=========================================================================
Differential Diagnosis
=========================================================================
● Urothelial carcinoma: need high threshold for this diagnosis after history of radiation therapy; no radiation associated changes of vascular ectasia or atypical fibroblasts (Hum Pathol 2000;31:678)
Additional references
=========================================================================
End of Bladder > Cystitis > Radiation cystitis
This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.
All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).