Bladder, ureter & renal pelvis
Cystitis
Cystitis cystica and cystitis glandularis


Minor changes: 30 June 2020

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PubMed Search: Cystitis cystica glandularis

Lindsey Durowoju, M.D.
Maria Tretiakova, M.D., Ph.D.
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Cite this page: Durowoju L, Tretiakova M. Cystitis cystica and cystitis glandularis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladdercystitiscystica.html. Accessed August 7th, 2020.
Definition / general
  • Proliferative or reactive changes occurring in von Brunn nests which acquire luminal spaces, become cystically dilated (cystitis cystica), undergo glandular metaplasia (cystitis glandularis) or intestinal type metaplasia (cystitis glandularis, intestinal type)
Essential features
  • Extremely common incidental finding
  • Develops in the setting of chronic mucosal irritation or inflammation
  • Cystitis cystica and cystitis glandularis are frequently coexisting interrelated lesions
  • Benign mimickers of invasive carcinoma
Terminology
  • Cystitis cystica et glandularis (when combined features)
  • Cystitis glandularis, conventional type
  • Cystitis glandularis, intestinal type (preferred term: intestinal metaplasia)
  • Proliferative cystitis (discouraged terminology)
ICD coding
  • ICD-10: N30.80 - Other cystitis without hematuria
  • ICD-10: N30.81 - Other cystitis with hematuria
Epidemiology
Sites
  • Bladder; neck and trigone are most common sites
  • Also ureters (ureteritis) and renal pelvis (pyelitis)
Pathophysiology
  • Reactive process in response to chronic irritation, infection, calculi, outlet obstruction, catheterization (Pathol Annu 1995;30:95)
  • Urothelium proliferates and invaginates into underlying lamina propria
Etiology
  • Chronic irritation / local inflammatory insult
Clinical features
  • Majority are asymptomatic incidental findings
  • May infrequently cause recurrent urinary tract infections
  • Occasionally appears as polypoid or papillary mass on cystoscopy
  • Cystitis glandularis can be associated with pelvic lipomatosis and bladder exstrophy
  • Reference: Pathol Annu 1995;30:95
Diagnosis
  • Diagnosis is by microscopic examination of resected tissue
Radiology description
Radiology images

Images hosted on other servers:

T1 weighted MRI

Transabdominal ultrasound

Prognostic factors
  • Reactive process without malignant potential
  • May regress if the cause of irritation is removed
Case reports
Treatment
  • Elimination of underlying source of irritation
  • Antibiotic therapy if associated with chronic urinary tract infections
  • Occasionally surgical resection (transurethral) may be necessary
  • References: BJU Int 2013;112:27, Indian J Urol 2016;32:329
Clinical images

Images hosted on other servers:

Cystoscopy

Gross description
  • Mucosa may appear grossly unremarkable
  • Cystitis cystica appears as translucent submucosal cysts, mostly < 5 mm diameter
  • Cystitis glandularis appears as irregular or nodular lesions with a cobblestone pattern or as a polypoid mass
  • References: Pathol Annu 1995;30:95, Histopathology 2011;58:811
Microscopic (histologic) description
  • Abundant urothelial von Brunn nests
    • Often exhibit a vaguely lobular distribution of invaginations
    • Noninfiltrative growth and variable connection to surface
  • Gland-like lumens with columnar or cuboidal cells (cystitis glandularis)
  • Cystically dilated lumens or cystic cavities filled with eosinophilic fluid (cystitis cystica)
  • Majority of cases show coexistence of both patterns
  • Cells lack significant atypia, mitotic activity, stromal reaction and muscular invasion (Ann Diagn Pathol 2019;38:11)
    • Degenerative atypia occasionally present
Microscopic (histologic) images

Contributed by Maria Tretiakova, M.D., Ph.D.

Cystitis cystica

Cystitis glandularis

Immunofluorescence description
  • Cystitis glandularis demonstrates uniform membranous expression of beta catenin without cytoplasmic or nuclear localization (J Urol 2003;170:1892)
Positive stains
Sample pathology report
  • Bladder, trigone, biopsy:
    • Urothelium with florid cystitis cystica et glandularis
    • No neoplasm identified
    • Muscularis propria absent
Differential diagnosis
Additional references
Board review style question #1

A 75 year old man presents with a polypoid bladder lesion on cystoscopy. Which feature could be present in nested variant of invasive urothelial carcinoma but should not be found in this entity?

  1. Background inflammation
  2. Expression of CK7 and CK20
  3. Invasion into muscularis propria
  4. Irregular nests variably distributed within lamina propria
  5. Mild cytologic atypia
Board review answer #1
C. Invasion into muscularis propria. This is cystitis cystica.

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Reference: Cystitis cystica and cystitis glandularis
Board review style question #2
Which is true about cystitis cystica?

  1. Considered a premalignant lesion
  2. Immunohistochemically negative for urothelial markers
  3. Part of morphologic spectrum with cystitis glandularis
  4. Rare finding
  5. Variably sized cysts are filled with extravasated mucin
Board review answer #2
C. Part of morphologic spectrum with cystitis glandularis

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Reference: Cystitis cystica and cystitis glandularis
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