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

Turki Al-Hussain, M.D.
Monika Roychowdhury, M.D.
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Cite this page: Al-Hussain T, Roychowdhury M. Granulomatous cystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladdergranulomatouscystitis.html. Accessed November 28th, 2023.
Granulomatous cystitis
Definition / general
  • 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

Treatment

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
  • 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
  • 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

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
Microscopic (histologic) images

Images hosted on other servers:
Granulomatous cystitis due to bCG treatment Granulomatous cystitis due to bCG treatment

Granulomatous cystitis due to bCG treatment

Granulomatous cystitis, postresection

Granulomatous cystitis, postresection

Postoperative granulomas, postresection

Postoperative granulomas, postresection

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