Bladder, ureter & renal pelvis
Cystitis
Granulomatous cystitis
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Last staff update: 20 September 2023
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PubMed Search: Bladder granulomatous cystitis
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Granulomatous cystitis | Postoperative granulomas | Xanthogranulomatous cystitis | Microscopic (histologic) imagesCite this page: Al-Hussain T, Roychowdhury M. Granulomatous cystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladdergranulomatouscystitis.html. Accessed October 2nd, 2023.
Granulomatous cystitis
Definition / general
Etiology
Clinical features
Case reports
Treatment
Gross description
Microscopic (histologic) description
- Granulomas in bladder, due to various infectious or treatment related causes
Etiology
- Tuberculosis, bCG (bacillus Calmette-Guerin) treatment for papillary urothelial carcinoma, biopsy / resection, Schistosoma haematobium infection, actinomycosis
Clinical features
- Tuberculosis: rare in most countries; bladder lesions near trigone, smaller lesions merge over time into large ulcers; may involve prostate or vagina; often secondary infection from kidney
- bCG: used to treat high grade papillary carcinoma or carcinoma in situ of bladder
- Post biopsy / resection: present in 14% with 2 surgical procedures
Case reports
- Primary vesical actinomycosis (Int J Urol 2007;14:969)
Treatment
- Possibly bladder botulinum toxin A injection to increase bladder capacity (BJU Int 2008;102:704)
Gross description
- Can present as mass / polypoid lesion
Microscopic (histologic) description
- Tuberculosis: caseating granulomas with Langhans giant cells, mostly in lamina propria with mucosal ulceration
- bCG: induces chronic inflammation, superficial ulceration and noncaseating granulomas with active and chronic inflammation; changes may extend into prostate (Am J Clin Pathol 1993;99:244)
- Post biopsy / resection: either necrotizing and palisading, resembling rheumatoid nodules or foreign body type (without foreign material) or both (Am J Clin Pathol 1986;86:430)
- Actinomycosis: scattered lymphoid follicles and nonspecific inflammation with or without intermixed colonies of Actinomyces
Postoperative granulomas
Definition / general
Etiology
Microscopic (histologic) description
Differential diagnosis
- Reactive lesion that occurs after catheterization or diathermy (Acta Pathol Jpn 1986;36:1813)
- Foreign body granulomas may occur postbladder neck suspension or other surgery (Int Urol Nephrol 2001;33:351, Am J Clin Path 1986;86:430)
Etiology
- May be due to metals deposited during diathermy, local reaction to tissue necrosis or hypersensitivity reaction (Urology 1990;35:454)
- Includes starch granulomas (Urology 1976;8:507)
Microscopic (histologic) description
- Palisading histiocytes or giant cells surrounding central necrosis (resembling rheumatoid nodules) or foreign body type granuloma
- Lesions heal by fibrous scarring
Differential diagnosis
- Granulomatous cystitis:
- Terms may overlap; often refers to patients with infectious etiology and no distinct mass
Xanthogranulomatous cystitis
Definition / general
Clinical features
Case reports
Treatment
Microscopic (histologic) description
Positive stains
Negative stains
Differential diagnosis
- Rare (< 50 cases reported in bladder) inflammatory disorder characterized by lipid laden macrophages
Clinical features
- Benign but associated with malignancy in some cases (Histopathology 1998;33:212)
- Associated with xanthogranulomatous pyelonephritis, urachal adenomas, inflammatory bowel disease
Case reports
- 50 year old man with multiple small polypoidal growths (Int Urol Nephrol 2007;39:477)
- 76 year old man with painless hematuria and bladder mass (Int Urogynecol J Pelvic Floor Dysfunct 2007;18:1233)
Treatment
- Broad spectrum antibiotics; possibly resection
Microscopic (histologic) description
- Lipid laden macrophages, plasma cells and lymphocytes
- May have some Touton type giant cells
- Similar to malakoplakia but without Michaelis-Gutmann bodies
Positive stains
Negative stains
Differential diagnosis
- Malakoplakia:
- Has Michaelis-Gutmann bodies
- Urothelial carcinoma:
- Cytokeratin positive
Microscopic (histologic) images
Images hosted on other servers:
Granulomatous cystitis due to bCG treatment
Granulomatous cystitis, postresection
Postoperative granulomas, postresection
