A new resection of the irregularity of the bladder neck mucosa and vesical trigone revealed glandular cystitis. The patient underwent another series of BCG treatments. Two years later the patient presented no voiding complaints, urinary flow was better than before, and ejaculations were normal. Cultures of urine and urinary cytology were normal. The cystoscopy showed irregular urothelium at the bladder neck and trigone, and the biopsy of these areas did not reveal the previous abnormal findings.
The metaplastic alterations of the vesical transitional epithelium in glandular cystitis are well documented in the literature, although the etiology is not yet completely clarified. Chronic inflammation of the lamina propria causes proliferation of the epithelium resulting in invagination, with formation of nests, crypts, and, in some cases, actual enteric glands.
It can be preceded or associated with other prolifer ative non-neoplastic lesions such as Von Brunn nests, cystic cystitis, follicular cystitis, and polypoid cystitis. Unlike the glandular cystitis, polypoid cystitis arises from the extrinsic proliferation of the epithelium above the lamina propria, with formation of small villous projections. It can remain as a benign process for years, or it can turn into an autonomous growth and produce a solid papillary invasive tumor.
Investigating autopsy samples, Morse 4 concluded that these epithelial alterations are more common in people over 20 years and that they would problably be related to chronic inflammations of the urinary tract, 2,5 as can be observed in schistosomiasis. Another etiologic hypothesis is based on embryonal remnants that originate in the urogenital sinus leading to the formation of actual enteric glands, with or without mucosal contents in the bladder.
Metaplasias of the vesical mucosa can also result from embryonal remains of skin scamous metaplasia , or from a primitive kidney nephrogenic adenomas. Some authors consider glandular cystitis to be a histologic curiosity without any clinical significance. Regarding the risk of glandular cystitis progressing to malignancy, there are studies that demonstrate a correlation between the reactivity of the antibody mAbDas 1 with columnar mucinous adenocarcinoma and glandular metaplasia.
In the incidentally diagnosed case that we are presently reporting, glandular cystitis presented as a pseudo-tumoral lesion. Because of the recurrence of lesions and of possible correlations with a malignant neoplasm, we chose to perform endoscopic resections and, following the procedure, to treat the condition using intravesical BCG until these histological alterations had disappeared.
Catalona W. Urothelial tumors of the urinary tract. In: Walsh PC. Negative stains. Sample pathology report. Bladder, trigone, biopsy: Urothelium with florid cystitis cystica et glandularis No neoplasm identified Muscularis propria absent. Differential diagnosis. Additional references. Board review style question 1. Board review style answer 1. Invasion into muscularis propria. This is cystitis cystica. Comment Here Reference: Cystitis cystica and cystitis glandularis.
Board review style question 2. Which is true about cystitis cystica? Considered a premalignant lesion Immunohistochemically negative for urothelial markers Part of morphologic spectrum with cystitis glandularis Rare finding Variably sized cysts are filled with extravasated mucin.
Board review style answer 2. Part of morphologic spectrum with cystitis glandularis Comment Here Reference: Cystitis cystica and cystitis glandularis.
Sign up for our Email Newsletters. Click here for information on linking to our website or using our content or images. Hypervascular polypoid masses within the urinary bladder, best delineated on delayed urography phase. Treatment consists of removing the source of irritation and surgical excision of the area of inflammation or cystectomy in rare severe cases. An association with adenocarcinoma of the bladder has been described, and thus these patients should be monitored.
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