Bladder, ureter & renal pelvis
Cystitis
Radiation cystitis
Author: Turki Al-Hussain, M.D.
Last author update: 1 September 2012
Last staff update: 31 January 2023 (update in progress)
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: Radiation cystitis[title]
Table of Contents
Definition / general | Clinical features | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Differential diagnosis | Additional referencesCite this page: Al-Hussain T. Radiation cystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladderradiationcystitis.html. 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
- 71 year old man with radiation therapy for prostate carcinoma (Arch Pathol Lab Med 2005;129:1067)
Treatment
- Severe hemorrhage is treated with topical application of formalin-soaked pledgets (Asian J Surg 2002;25:232)
- Argon-beam coagulator (BJU Int 2006;98:610)
- Possibly recombinant activated factor VII (Ir J Med Sci 2010;179:431)
Clinical images
Images hosted on other servers:
Cystoscopy
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
- Urothelial carcinoma:
- Need high threshold for this diagnosis after history of radiation therapy
- Has no radiation associated changes of vascular ectasia or atypical fibroblasts (Hum Pathol 2000;31:678)
Additional references
