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Dawman L, Peters NJ, Tiewsoh K, Bal A, Sodhi K, Samujh R. Bladder Mass Masquerading as Eosinophilic Cystitis in a Child: When to Think Beyond Malignancy? J Indian Assoc Pediatr Surg 2021; 26:51-53. [PMID: 33953514 PMCID: PMC8074822 DOI: 10.4103/jiaps.jiaps_36_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/04/2020] [Accepted: 04/26/2020] [Indexed: 11/09/2022] Open
Abstract
Eosinophilic cystitis is a rare inflammatory disease in the pediatric population with varied presentations. Diagnosis requires a high index of suspicion and cystoscopy with biopsy of the bladder mass. There are no standard treatment guidelines, however, these patients usually respond with medical management, but recurrence is a possibility. We present a case of eosinophilic cystitis in a 6-year-old boy who presented with lower urinary tract symptoms, gross hematuria, and bladder mass.
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Affiliation(s)
- Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin James Peters
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjeet Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Sodhi
- Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The aim of the present case report was to investigate the clinical features, pathological examination and treatment of eosinophilic cystitis (EC) in children. Two cases of EC were reported and reviewed from January 2016 to March 2017. Case 1 (male; 6 years old) had intermittent hematuria, frequent urination, urgent urination, difficulty in urination and abdominal pain. Case 2 (male; 7 years old) had frequent urination, urgent urination, urinary pain, dysuria and suprapubic pain with no hematuria. One patient had a history of allergies and both patients underwent a cystoscope biopsy. Blood eosinophils were clearly increased and a bone marrow biopsy examination revealed that marrow eosinophils were also increased in both cases. The urine culture results were negative. Ultrasonography and computed tomography revealed uneven thickening of the bladder wall and diffusive mucosal lesions. Cystoscopy revealed that the bladder volume became smaller and the mucosa at the bladder floor and neck was red. Lesions were biopsied through the urethra and the following characteristics were observed: Congestion and edema of the bladder mucosa, infiltration of the blood vessels and eosinophils in the muscular layer, accompanied by focal muscle necrosis. Patient 1 was administered anti-inflammatory and cetirizine hydrochloride treatments, followed by 6 weeks of prednisone dose-reduction therapy. Patient 2 was administered antibiotics and cetirizine hydrochloride. Following 6-month follow-ups, abnormal voiding symptoms had disappeared in each case. Ultrasonography and computed tomography revealed no bladder wall thickening or space-occupying lesions. EC in children is rare and easily misdiagnosed as nonspecific bladder inflammation or bladder occupying lesions. Cystoscopy and biopsy are necessary to diagnose EC and conservative treatments with anti-inflammatory, anti-allergic and cortical hormone nonspecific treatments are suggested.
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Bey E, Teklali Y, Rabattu PY, Lapierre SG, Piolat C. Case: Eosinophilic cystitis presenting as a bladder mass in an 11-year-old girl. Can Urol Assoc J 2017; 11:E446-E448. [PMID: 29072568 DOI: 10.5489/cuaj.4513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the case of an 11-year-old girl who presented with acute urinary retention and microscopic hematuria. Pelvic imaging revealed a bladder mass for which sarcoma was initially suspected. Surgical biopsies revealed a massive eosinophilic infiltration of the submucosa confirming a diagnosis of eosinophilic cystitis. Clinical evolution was favourable without treatment. Eosinophilic cystitis prognosis is usually benign, but rare severe complications, such as complete bladder fibrosis requiring bladder augmentation or cystectomy, may occur.
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Affiliation(s)
- Elsa Bey
- Department of Pediatric Surgery, University Hospital of Grenoble, France.,Department of Urology and Renal Transplantation, University Hospital of Grenoble, France
| | - Youssef Teklali
- Department of Pediatric Surgery, University Hospital of Grenoble, France
| | | | - Simon Grandjean Lapierre
- Department of Microbiology and Infectious Diseases, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Christian Piolat
- Department of Pediatric Surgery, University Hospital of Grenoble, France
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Kilic O, Akand M, Gul M, Karabagli P, Goktas S. Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24562. [PMID: 27621918 PMCID: PMC5002967 DOI: 10.5812/ircmj.24562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/25/2015] [Accepted: 05/17/2015] [Indexed: 12/05/2022]
Abstract
Introduction Eosinophilic cystitis (EC) is a rare and poorly understood inflammatory condition, characterized by eosinophilic infiltration of all layers of the bladder wall, which mimics bladder tumors. EC may present with symptoms such as increased urination frequency, dysuria, gross/microscopic hematuria, suprapubic pain and urinary retention. Case Presentation We present a 17-year-old male patient, who was continent night and day in his childhood, and was admitted to our clinic for complaints of hematuria and nocturnal enuresis for the past six months. His history and physical examination were unremarkable, and routine hematological and biochemical tests were normal. Cystoscopy revealed a 4 × 3 cm erythematous, polypoidal, solid lesion on the bladder dome. Histopathological examination of the lesion revealed transitional epithelium with stromal edema, where diffuse, dense infiltration of lamina propria by eosinophils and lymphocytes was also seen. According to these findings, a histopathological diagnosis of EC was made, and the patient was treated with corticosteroids, antimicrobial agents and antihistamines. His symptoms dramatically improved and nocturnal enuresis also recovered after treatment. Conclusions Although it is a rare entity, EC should be kept in mind in the differential diagnosis of patients presenting with dysuria, hematuria and any kind of acquired voiding dysfunction, including frequency, pollakiuria and incontinence.
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Affiliation(s)
- Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
- Corresponding Author: Murat Akand, Department of Urology, School of Medicine, Selcuk University, Konya, Turkey. Tel: +90-5327438333, Fax: +90-3322412184, E-mail:
| | - Murat Gul
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Pinar Karabagli
- Department of Pathology, School of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Goktas
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
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Sparks S, Kaplan A, DeCambre M, Kaplan G, Holmes N. Eosinophilic cystitis in the pediatric population: a case series and review of the literature. J Pediatr Urol 2013; 9:738-44. [PMID: 23391564 DOI: 10.1016/j.jpurol.2012.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE Eosinophilic cystitis is a rarely seen condition in the pediatric population with indistinct symptomatology and non-standardized treatment protocols. We review our experience of treating patients with this condition. MATERIALS AND METHODS We retrospectively reviewed the records of four patients from a single institution who have been diagnosed and treated for eosinophilic cystitis. In addition, the literature was reviewed for cases of pediatric eosinophilic cystitis. Our patients were added and compared to this cohort. RESULTS Our patients included 3 females and 1 male who range in age from 5 days to 18 years (5 days, 1 month, 7 years, 18 years). Both of the infants presented with a suprapubic mass and bilateral hydroureteronephrosis. The two older patients both had dysuria while the 18 yo also complained of fatigue, flank pain, and hematuria. Only 2 of the 4 patients were found to have significant peripheral eosinophilia and only one patient had eosinophiluria. All of the patients were diagnosed via cystourethroscopy with biopsy. Treatment in each case consisted of a combination of steroids, antihistamines, and antibiotics. CONCLUSIONS The presentation of eosinophilic cystitis is varied and diagnosis requires a high index of suspicion. Cystourethroscopy with biopsy is essential to establish the diagnosis as there is no typical appearance of the lesions or presenting signs/symptoms. Most cases of eosinophilic cystitis are responsive to medical therapy although in some cases recurrence may be noted.
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Affiliation(s)
- S Sparks
- Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, USA.
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Eosinophilic cystitis: a rare cause of hematuria in children. Case Rep Nephrol 2012; 2012:710230. [PMID: 24558612 PMCID: PMC3914238 DOI: 10.1155/2012/710230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/13/2012] [Indexed: 11/17/2022] Open
Abstract
A 7-year-old boy presented with a history of acute onset of hematuria, dysuria, and suprapubic pain. Urine routine and microscopy showed 40-45 red cells/high power field. Urine culture was sterile. Radiological investigations showed a focal mucosal lesion with bladder wall thickening. Biopsy of the lesion revealed an edematous mucosa with florid infiltration by eosinophils into the muscularis propria with focal areas of myonecrosis. He was diagnosed as a case of eosinophilic cystitis. The patient received 6 weeks of tapered prednisone therapy. He was asymptomatic on followup.
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[Eosinophilic cystitis in children]. Arch Pediatr 2011; 18:550-2. [PMID: 21489763 DOI: 10.1016/j.arcped.2011.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 04/01/2010] [Accepted: 02/16/2011] [Indexed: 11/22/2022]
Abstract
Eosinophilic cystitis (EC) is a rare disease that frequently suggests a bladder tumour at presentation. It affects both children and adults and its pathophysiology remains unclear. EC usually shows a benign course, but serious complications can occur and relapsing forms have been described. It has rarely been reported in children and therefore, might be poorly known by physicians and underdiagnosed. We report a case that differs from other observations by its unusually rapid resolution, and review the literature on EC's diagnosis, treatment, and course in children.
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Abstract
Benign diseases of the bladder often present diagnostic challenges to practicing pathologists due to their diverse nature and ability to mimic a variety of epithelial or mesenchymal neoplasms. Categories of benign bladder disease include infectious cystitis, noninfectious cystitis, reactive proliferative processes, and benign processes that secondarily involve the bladder. An understanding of the key clinical and morphologic features of these lesions and the useful ancillary techniques specific for these entities is critical to the correct diagnosis of these lesions. This article reviews the key features of these benign bladder diseases and highlights methods to distinguish these lesions from other benign and malignant processes involving the bladder.
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Affiliation(s)
- Joshua F Coleman
- Department of Anatomic Pathology, The Cleveland Clinic, 9500 Euclid Avenue, Desk L25, Cleveland, OH 44195, USA
| | - Donna E Hansel
- Department of Anatomic Pathology, Glickman Urological and Kidney Institute, Taussig Cancer Institute, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, 9500 Euclid Avenue, Desk L25, Cleveland, OH 44195, USA.
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Affiliation(s)
- John C Thomas
- Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Barese CN, Podestá M, Litvak E, Villa M, Rivas EM. Recurrent eosinophilic cystitis in a child with chronic granulomatous disease. J Pediatr Hematol Oncol 2004; 26:209-12. [PMID: 15125617 DOI: 10.1097/00043426-200403000-00014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eosinophilic cystitis is an uncommon disease in children, and its association with chronic granulomatous disease (CGD) has been previously reported in only five patients. In all those patients the disease showed either a self-limited benign course or a rapid response to corticosteroid treatment. The authors describe a child with X-linked CGD who developed eosinophilic cystitis with a recurrent course and difficult therapeutic management. The authors also discuss the pathogenesis of granuloma formation in CGD and review the literature for current therapies for these complications.
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Affiliation(s)
- Cecilia N Barese
- Division of Immunology, Hospital de Niños "Dr. Ricardo Gutierrez", Associated Hospital to the Universidad de Buenos Aires, Argentina.
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Abstract
We describe four cases of eosinophilic cystitis in whom no specific cause could be found, and review the literature. Complaints at presentation included urgency, frequency, abdominal pain, and haematuria. In three patients the symptoms and ultrasound pictures suggested a bladder tumour. One patient was treated with anticholinergics and corticosteroids without relief of symptoms; a localised eosinophilic tumour was excised in one patient who remained symptom free; and two patients were managed conservatively with spontaneous resolution of bladder pathology and symptoms. One case was identified by random bladder biopsy in 150 consecutive patients with unexplained irritable micturition complaints. Eosinophilic cystitis is rare in children. After biopsy, we consider a wait and see policy is justified as symptoms tend to disappear spontaneously. Routine bladder biopsies in children with unexplained bladder symptoms is not justifiable.
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Affiliation(s)
- P C Verhagen
- Department of Urology, University Hospital Dijkzigt, PO Box 2040, 3000 CA Rotterdam, Netherlands
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Sano K, Terashima K, Gotoh K, Ijiri R, Tanaka Y. A case of eosinophilic cystitis in a 5-year-old boy. Int J Urol 2000; 7:54-6; discussion 57. [PMID: 10710248 DOI: 10.1046/j.1442-2042.2000.00135.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eosinophilic cystitis (EC) is rather an uncommon disease in childhood. A case of EC in a 5-year-old boy, in which open biopsy was needed for final diagnosis, is reported. After diagnosis, he was treated with pemirolast potassium followed-up with eosinophil cationic protein (ECP) in serum and urine. Eosinophil cationic protein is an appropriate marker of EC.
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Affiliation(s)
- K Sano
- Department of Urology, Kanagawa Children s Medical Center, Yokohama, Japan
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