Bladder, ureter & renal pelvis
Cystitis
Bullous cystitis
Author: Mirna Toukatly, M.D.
Last author update: 1 July 2015
Last staff update: 23 November 2020
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: Bullous cystitis [title]
Table of Contents
Definition / general | Terminology | Epidemiology | Etiology | Clinical features | Radiology description | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Toukatly M. Bullous cystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladderbullouscystitis.html. Accessed September 21st, 2023.
Definition / general
- Reversible inflammatory condition of bladder mucosa with extensive submucosal edema
Terminology
- An endoscopic term referring to bullous appearing edematous bladder mucosa, that mimics neoplastic bladder lesions
- A variant of polypoid cystitis, but with broader based and larger lesions
Epidemiology
- Wide age variation from young children to adults
- Associated with chronic cystitis in girls
Etiology
- Chronic irritation (chronic catheter use, neuromuscular ureteral dysplasia, vesicoureteral reflux or urolithiasis)
- Association with bullous pemphigoid (BP) has been suggested in at least on case report; expression of BP180 has been demonstrated in the transitional epithelium of the bladder by indirect immunofluorescence
- In addition, BP230 has been demonstrated by immunofluorescence in a rat bladder tumor cell line
- May be associated with an acute infection (hip arthritis, gonorrheal pelvic inflammatory disease)
Clinical features
- May be asymptomatic or present with dysuria, extreme frequency and urgent micturition responsible for pseudo-urinary incontinence
- If located in the trigone and periureteral zone, may produce transient acute ureteral obstruction
Radiology description
- Pelvic CT and MRI may demonstrate thickening of bladder wall
- Intravenous urography and sonography may show hypoechoic mucosa and nodular filling defects caused by the edema, and if prominent, ureteral obstruction
- This may be radiographically indistinguishable from bladder carcinoma
Prognostic factors
- Intermediate severity; usually reversible
Case reports
- Child with chronic cystitis (J Urol (Paris) 1981;87:523)
- 25 year old man with bullous cystitis (Hinyokika Kiyo 1989;35:493)
- 52 year old man with bullous pemphigoid and bullous cystitis (J Am Acad Dermatol 2014;71:e102)
- AIDS patient with pseudo-tumoral cystitis due to Toxoplasma (Prog Urol 1995;5:270)
- Two boys with acute ureteral obstruction secondary to bullous cystitis of trigone (Radiology 1979;132:351)
Treatment
- Usually treated by removing the offending agent (catheter) or the infectious or inflammatory condition (such as in BP)
- Surgery may be needed to correct a vesicoureteral reflux
Gross description
- On cystoscopy, bladder shows numerous bullae with a pseudoneoplastic appearance
- Changes seen are a thickened mucosa that is smooth in early stages and becomes redundant and polypoid in later stages
Microscopic (histologic) description
- Broad bulbous projections of mucosa with prominent submucosal edema, acute and chronic inflammation, lymphangiectasis
- Urothelium may show reactive atypia, focal or diffuse thickening
- Congenital mucosal variants include overdevelopment of lymphoid tissue as massive lymphoid follicles and a lymphangiectatic form (Urologiia 2000;1:3)
Microscopic (histologic) images
Images hosted on other servers:
Many eosinophils
Differential diagnosis
- Papillary urothelial neoplasms: delicate fibrovascular cores and cell atypia
- Polypoid / papillary and other forms of cystitis: lack prominent edema
Additional references
