Bladder, ureter & renal pelvis


Radiation cystitis

Last author update: 1 September 2012
Last staff update: 31 January 2023 (update in progress)

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PubMed Search: Radiation cystitis[title]

Turki Al-Hussain, M.D.
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Cite this page: Al-Hussain T. Radiation cystitis. website. Accessed April 1st, 2023.
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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