Bladder, ureter & renal pelvis


Radiation cystitis

Topic Completed: 1 September 2012

Minor changes: 15 November 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Radiation cystitis[title]

Turki Al-Hussain, M.D.
Page views in 2020: 2,115
Page views in 2021 to date: 2,172
Cite this page: Al-Hussain T. Radiation cystitis. website. Accessed December 6th, 2021.
Definition / general
  • Acute or chronic histologic changes associated with radiation therapy
Clinical features
  • Histologic and clinical changes are time and dose dependent
  • Symptoms include urinary frequency, urgency, voiding pain and gross hematuria
  • Early signs may appear 4-6 weeks after initiation of therapy
  • Late reactions may appear between 3 months and 10 years (Am J Surg Pathol 1978;2:159)
  • 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
Case reports
Clinical images

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Microscopic (histologic) description
  • 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
  • These changes may persist for longer intervals in von Brunn’s nest (Epstein: Bladder Biopsy Interpretation, 2003)
  • May have pseudoinvasive urothelial nests wrapping around the vessels associated with fibrin deposition and hemorrhage - so called pseudocarcinomatous epithelial hyperplasia (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
Differential diagnosis
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