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Nasrallah OG, Balaghi A, El Sayegh N, Mahdi JH, Sinno S, Nasr RW. Florid Cystitis Glandularis with Intestinal Metaplasia in the Prostatic Urethra: a case report and review of the literature. Int J Surg Case Rep 2024; 116:109416. [PMID: 38422750 PMCID: PMC10943984 DOI: 10.1016/j.ijscr.2024.109416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Cystitis glandularis is a proliferative disease of the bladder epithelium usually presenting in the setting of chronic inflammation, characterized by the formation of glands in the bladder mucosa and submucosa. Intestinal metaplasia is a described process in cystitis glandularis characterized by the presence of intestinal cells and mucin production which is rare as compared to cystitis glandularis. CASE PRESENTATION We present a case of cystitis glandularis with intestinal metaplasia located in the bladder and concomitantly in the prostatic urethra. Patient underwent transurethral resection of the lesion which was unusually found in the prostatic urethra. CLINICAL DISCUSSION Florid cystitis glandularis is a rare condition found in women more than in men. It usually presents with irritative lower urinary tract symptoms or hematuria which leads to its eventual diagnosis. It is usually causes by inflammation to the bladder mucosa due to infections or irritation. Patients are diagnosed through Transurethral resection of these bladder lesions found in the trigone and bladder neck region. Surgery is the standard treatment of choice. However, medical treatment may also be used to treat underlying inflammatory conditions using antibiotics, steroids, and non-steroidal anti-inflammatory agents. Radical or partial cystectomy may be performed for severe refractory cases. CONCLUSION This article describes the rare occurrence of florid cystitis glandularis in the prostatic urethra and provides an overview on diagnosis, etiology, and management of the disease.
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Affiliation(s)
- Oussama G Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alaa Balaghi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Noura El Sayegh
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana H Mahdi
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Sara Sinno
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami W Nasr
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Zhang T, Yin SF, Feng WB, Ke CX. Florid cystitis glandularis (intestinal type) with mucus extravasation: Two case reports and literature review. Front Surg 2023; 10:1048119. [PMID: 36911607 PMCID: PMC9998551 DOI: 10.3389/fsurg.2023.1048119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Cystitis glandularis is a common bladder epithelial lesion characterized by hyperplasia and metaplasia of the bladder mucosa epithelium. The pathogenesis of cystitis glandularis of the intestinal type is unknown and less common. When cystitis glandularis (intestinal type) is extremely severely differentiated, it is called florid cystitis glandularis (the occurrence is extremely rare). Case summary Both patients were middle-aged men. In patient 1, the lesion was also seen in the posterior wall and was diagnosed more than 1 year ago as cystitis glandularis with urethral stricture. Patient 2 was examined for symptoms such as hematuria and was found to have an occupied bladder; both were treated surgically, and the postoperative pathology was diagnosed as florid cystitis glandularis (intestinal type), with mucus extravasation. Conclusion The pathogenesis of cystitis glandularis (intestinal type) is unknown and less common. When cystitis glandularis of the intestinal type is extremely severely differentiated, we call it florid cystitis glandularis. It is more common in the bladder neck and trigone. The clinical manifestations are mainly symptoms of bladder irritation, or hematuria as the main complaint, which rarely leads to hydronephrosis. Imaging is nonspecific and the diagnosis depends on pathology. Surgical excision of the lesion is possible. Due to the malignant potential of cystitis glandularis of intestinal type, postoperative follow-up is required.
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Affiliation(s)
- Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Si-Fan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wen-Bo Feng
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang-Xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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CircTHBS1 targeting miR-211/CCND2 pathway to promote cell proliferation and migration potential in primary cystitis glandularis cells. Biosci Rep 2021; 41:226170. [PMID: 32820798 PMCID: PMC8360828 DOI: 10.1042/bsr20201164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022] Open
Abstract
The pathogenesis of cystitis glandular (CG) is unclear, but it is generally considered to be a neoplastic lesion of urothelial hyperplasia formed by long-term chronic stimulation. There is growing evidence that circRNAs play important roles in a variety of cellular processes. However, there are few reports on the role and molecular mechanism of circRNA in CG. In the present study, we first isolated primary cells from CG tissues and adjacent normal tissues. Further experiments showed that CircTHBS1 was up-regulated in primary CG cells (pCGs). The results of CCK-8 showed that the overexpression of CircTHBS1 promoted the viability of pCGs, while the deletion of CircTHBS1 reduced the cell viability. Knocking out CircTHBS1 also inhibited the migration of pCGs. In addition, we demonstrated that CircTHBS1 played a role in the adsorption of miR-211 by “sponge” in pCG. In turn, miR-211 can directly target CYCLIN D2 (CCND2) 3′UTR to perform its function. Finally, we confirmed the role and mechanism of CircTHBS1/miR-211/CCND2 regulation axis in pCGs. In summary, our study is the first to reveal the role and underlying mechanism of CircTHBS1 in CG, providing a potential biomarker and therapeutic target for human CG.
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Garg H, Singh P, Nayak B, Nayyar R, Kaushal S, Kumar R, Seth A. Understanding an unusual urothelial disorder: cystitis cystica et glandularis. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To study the presentation and natural course of cystitis cystica et glandularis. Methods: A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years’ follow-up was performed. Perioperative details along with the last available follow-up were included in the analysis. Results: A total of 10 patients were included. The mean age (± standard deviation) was 33.4 (±14.0) years and nine (90%) were men. The most common presentation was storage and voiding lower urinary tract symptoms (80%) along with haematuria (40%) and dysuria (20%). Four patients had the presence of hydronephrosis in preoperative imaging, of which three patients had bilateral mild hydroureteronephrosis. All the patients underwent transurethral resection of the bladder tumour as all were diagnosed with urinary bladder mass on preoperative imaging. All the patients had a trigonal lesion with a bullous appearance partially obstructing the bladder neck. Six patients underwent double J stenting in the perioperative period. The mean (± standard deviation) follow-up duration was 32.8 (±7.5) months. Patients were kept on regular surveillance with imaging and cystoscopy as indicated. Eight patients (80%) developed recurrence in the follow-up period. The mean number of recurrences was 1.5 (±1.1). One of the patients had to undergo augmentation ileocystoplasty with bilateral ureteric reimplantation because of the recurrent lesion with small contracted bladder, while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. Besides, there was no evidence of malignancy after this entity in any of the patients. Conclusion: Cystitis cystica et glandularis is a rare clinic pathological entity which often mimics bladder tumour. Cystitis cystica et glandularis is common in men and often presents with lower urinary tract symptoms. Transurethral resection forms the mainstay of treatment. However, it is often associated with upper tract hydronephrosis. Its controversial premalignant nature compounded with recurrence and risk of upper tract deterioration warrants close surveillance. Level of evidence: 4
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Samaratunga H, Delahunt B, Yaxley J, Egevad L. Tumour-like lesions of the urinary bladder. Pathology 2020; 53:44-55. [PMID: 33070959 DOI: 10.1016/j.pathol.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
There are a number of benign epithelial proliferations in the bladder that may be difficult to distinguish from carcinomas, including urothelial carcinoma and its variants, squamous cell carcinoma and adenocarcinoma. If misdiagnosed, there is the potential for over treatment, with its attendant risk of complications, as well as errors relating to prognostic assessment. In the case of the misdiagnosis of high grade proliferative lesions that mimic invasive carcinoma, unnecessary radical surgery, chemotherapy and radiotherapy may result. Similarly, the misdiagnosis of lesions that have the appearance of low grade carcinoma can prompt a lifetime of radiological investigation and cystoscopies. In this review, we discuss a variety of entities that may be diagnostically challenging and emphasise the importance of identifying key morphological features that have diagnostic utility. We also highlight the importance of relevant clinical information and the clinical settings in which these lesions may occur. In this review we have divided the lesions on the basis of morphology in order to facilitate discussion relating to the differential diagnosis. The architectural patterns we discuss include papillary lesions (polypoid/papillary cystitis and papillary urothelial hyperplasia), pseudocarcinomatous proliferations (pseudocarcinomatous urothelial hyperplasia, florid proliferation of von Brunn nests and fibroepithelial polyps), glandular lesions (intestinal metaplasia and müllerianosis) and lesions with several different patterns (prostatic type urethral polyps and nephrogenic adenoma or metaplasia).
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Affiliation(s)
- Hemamali Samaratunga
- Aquesta Uropathology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Brett Delahunt
- Aquesta Uropathology, Brisbane, Qld, Australia; Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago-Wellington, Wellington, New Zealand
| | | | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Agrawal A, Kumar D, Jha AA, Aggarwal P. Incidence of adenocarcinoma bladder in patients with cystitis cystica et glandularis: A retrospective study. Indian J Urol 2020; 36:297-302. [PMID: 33376267 PMCID: PMC7759183 DOI: 10.4103/iju.iju_261_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/18/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction: Cystitis cystica et glandularis (CCG) is a hyper proliferative condition, likely representing a local immune response to chronic inflammatory stimulus. It has been hypothesized as a potential precursor of adenocarcinoma; however, a definite association has not been demonstrated. We aimed to determine whether CCG is a precursor to malignancy and to study the correlation of its two histological variants: the typical and the intestinal metaplasia (IM) type CCG. Materials and Methods: In this retrospective study, all the cases of CCG diagnosed and treated between January 2012 and December 2019 were analyzed. All the cases were followed up cystoscopically and biopsies were taken if the lesion persisted. The development of adenocarcinoma during the follow-up was noted. The patients were divided into two groups based on the histological subtype, i.e., the typical type and the IM type, and the two groups were also compared in terms of presentation, cystoscopic appearance, and development of adenocarcinoma. Results: A total of 64 patients, with 52 in the typical and 12 in the IM group were analyzed. The commonest symptom was hematuria (59.38%), followed by irritative bladder symptoms (51.56%). The median follow-up period was 5 years and 5 months (range: 7–96 months) and no patient progressed to adenocarcinoma. On comparing the two groups, the lesions weresignificantly more extensive in the IM group (50% vs. 15.38%). However, there were no differences in the symptoms or the development of malignancy between the two groups. Conclusions: At a median of 5 years and 5 months of follow up, CCG (including the IM-type) did not show any increase in the risk of malignancy.
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Affiliation(s)
- Amit Agrawal
- Department of Urology, Command Hospital (Western Command), Panchkula, Haryana, India
| | - Deepak Kumar
- Department of Urology, Command Hospital (Western Command), Panchkula, Haryana, India
| | - Aditya A Jha
- Department of Surgery, Military Hospital, Secundrabad, Telangana, India
| | - Puneet Aggarwal
- Department of Urology, Army Hospital (R and R), New Delhi, India
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Maurer A, Ortiz-Bruechle N, Guricova K, Rose M, Morsch R, Garczyk S, Stöhr R, Bertz S, Golz R, Reis H, Bremmer F, Zimpfer A, Siegert S, Kristiansen G, Schwamborn K, Gassler N, Knuechel R, Gaisa NT. Comparative genomic profiling of glandular bladder tumours. Virchows Arch 2020; 477:445-454. [PMID: 32198650 PMCID: PMC7443184 DOI: 10.1007/s00428-020-02787-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
Primary glandular bladder tumours (bladder adenocarcinoma [BAC], urachal adenocarcinoma [UAC], urothelial carcinoma with glandular differentiation [UCg]) are rare malignancies with histological resemblance to colorectal adenocarcinoma (CORAD) in the majority of this subgroup. Definite case numbers are very low, molecular data are limited and the pathogenesis remains poorly understood. Therefore, this study was designed to complement current knowledge by in depth analysis of BAC (n = 12), UAC (n = 13), UCg (n = 11) and non-invasive glandular lesions (n = 19). In BAC, in addition to known alterations in TP53, Wnt, MAP kinase and MTOR pathway, mutations in SMAD4, ARID1A and BRAF were identified. Compared to published data on muscle invasive bladder cancer (BLCA) and CORAD, UCg exhibited frequent "urothelial" like alterations while BAC and UAC were characterised by a more "colorectal" like mutational pattern. Immunohistochemically, there was no evidence of DNA mismatch repair deficiency or PD-L1 tumour cell positivity in any sample. Depending on the used antibody 0-45% of BAC, 0-30% of UCg and 0% UAC cases exhibited PD-L1 expressing tumour associated immune cells. A single BAC (9%, 1/11) showed evidence of ARID1A protein loss, and two cases of UCg (20%, 2/10) showed loss of SMARCA1 and PBRM1, respectively. Taken together, our data suggest at least in part involvement of similar pathways driving tumourigenesis of adenocarcinomas like BAC, UAC and CORAD independent of their tissue origin. Alterations of TERT and FBXW7 in single cases of intestinal metaplasia further point towards a possible precancerous character in line with previous reports.
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Affiliation(s)
- Angela Maurer
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadina Ortiz-Bruechle
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Karolina Guricova
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Michael Rose
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ronja Morsch
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
- Department of Urology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Stefan Garczyk
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Robert Stöhr
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Reinhard Golz
- Institute of Pathology, HELIOS Clinic Wuppertal, Wuppertal, Germany
| | - Henning Reis
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Annette Zimpfer
- Institute of Pathology, University Medical Center Rostock, Rostock, Germany
| | | | | | | | - Nikolaus Gassler
- Institute of Legal Medicine, Section Pathology, University Hospital Jena, Jena, Germany
| | - Ruth Knuechel
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadine T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
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McKenney JK. Precursor lesions of the urinary bladder. Histopathology 2019; 74:68-76. [PMID: 30565304 DOI: 10.1111/his.13762] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/19/2022]
Abstract
The classification of neoplastic precursor lesions in the urinary tract has evolved slowly with the gradual accumulation of clinicopathological data. Current nomenclature was codified most recently by the 2016 WHO classification, which is based on primary data with clinical outcome, consensus group statements and considerations of practical utility in routine diagnosis. This review discusses precursor lesions of urothelial, squamous and glandular lineage. For urothelial neoplasia, both flat lesions with atypia and early 'difficult-to-classify' proliferations are considered. Subtypes of squamous metaplasia, florid non-invasive squamous proliferations and frank squamous dysplasia are also addressed. Finally, rare glandular precursors of adenocarcinoma are reviewed, to include intestinal metaplasia, glandular dysplasia and villous adenoma. For each category, morphology (including differential diagnostic considerations), immunohistochemistry and any known molecular correlates are detailed. The goal is to provide a concise, practical up-to-date overview of this complex topic.
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Affiliation(s)
- Jesse K McKenney
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
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Kryvenko ON, Epstein JI. Mimickers of urothelial neoplasia. Ann Diagn Pathol 2019; 38:11-19. [DOI: 10.1016/j.anndiagpath.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 01/12/2023]
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Yi X, Lu H, Wu Y, Shen Y, Meng Q, Cheng J, Tang Y, Wu F, Ou R, Jiang S, Bai X, Xie K. Cystitis glandularis: A controversial premalignant lesion. Oncol Lett 2014; 8:1662-1664. [PMID: 25202387 PMCID: PMC4156188 DOI: 10.3892/ol.2014.2360] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 06/24/2014] [Indexed: 12/14/2022] Open
Abstract
Cystitis glandularis (CG) has been hypothesized as a potential precursor of adenocarcinoma, although this remains controversial. The present study reports data accumulated from 166 cases of cystitis glandularis with follow-up periods ranging between 0.5 and 17 years. The association between intestinal and typical CG and bladder carcinoma was retrospectively evaluated. The patients included in the present study had presented with typical (n=155) or intestinal (n=11) CG between 1994 and 2010. Of those patients, concurrent carcinoma of the bladder was identified in 15 (9.0%) patients, including two cases of squamous cell carcinoma and 1 case of sarcoma. The cases of carcinoma were identified either prior to or concurrently with the diagnosis of CG. Follow-up was available for 9/11 (81.8%) patients with intestinal CG. Nine months following transurethral fulguration, 8/11 (72.7%) patients were in complete remission and 1/11 (9.1%) complained of urgency and dysuria; two patients were lost to follow-up. The follow-up of the patients ranged from 0.7 to 4.5 years (median, 2.67 years; mean, 2.82 years). No evidence of subsequent carcinoma was identified in any of the patients during the follow-up of the intestinal and typical CG groups. In addition, there was no evidence of carcinoma subsequent to CG in either of the typical or intestinal CG groups. The results did not support that CG increases the future risk of malignancy in the short term and repeated cystoscopies over a short period of time are not recommended.
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Affiliation(s)
- Xianlin Yi
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Haoyuan Lu
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Yuexian Wu
- Department of Respiratory Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yang Shen
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Qinggui Meng
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Jiweng Cheng
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Yong Tang
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Fengxue Wu
- Emergency Department, Jingzhou Hospital of Tongji Medical College of Huazhong, Wuhan, Hubei 432020, P.R. China
| | - Rubiao Ou
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
| | - Shaojun Jiang
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
| | - Xianzhong Bai
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Keji Xie
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
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Clouston D, Lawrentschuk N. Metaplastic conditions of the bladder. BJU Int 2013; 112 Suppl 2:27-31. [PMID: 24127673 DOI: 10.1111/bju.12378] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD? Urologists are often confronted with cystoscopic appearances that at times are abnormal but non-specific, may mimic urothelial carcinoma or in some instances are quite bizarre given the clinical scenarios in which they occur (e.g. changes associated with a catheter will be more obvious than a de-novo presentation of cystitis cystica). Metaplasias of the bladder urothelium make up the majority of such cases. Furthermore, when confronted with a pathological diagnosis of a metaplasia within the bladder- what are the implications for the patient and how should they be followed-up? This review provides a concise summary of the pathological features of the various metaplasias that occur in the bladder and briefly describes their current treatment and requirement for follow-up. Metaplasia of the bladder urothelium occurs commonly in response to local injury. Usually the changes are reversible, but some conditions may be premalignant. This review describes the different metaplastic entities and their clinical significance. Most importantly, keratinising squamous metaplasia is a precursor to the development of bladder cancer, and requires treatment and long term follow up. The role of intestinal metaplasia in the development of cancer is uncertain, and these patients require follow-up until further evidence is obtained on the outcome of this entity.
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Affiliation(s)
- David Clouston
- TissuPath Pathology Service, 96 Ricketts Road, Mount Waverley, Vic, 3149
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13
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Hodges KB, Lopez-Beltran A, MacLennan GT, Montironi R, Cheng L. Urothelial lesions with inverted growth patterns: histogenesis, molecular genetic findings, differential diagnosis and clinical management. BJU Int 2010; 107:532-7. [DOI: 10.1111/j.1464-410x.2010.09853.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Wei Z, Ye Z, Chen Z. Expression of hTERT, p53 and PCNA in cystitis glandularis. ACTA ACUST UNITED AC 2010; 27:437-9. [PMID: 17828505 DOI: 10.1007/s11596-007-0422-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Indexed: 10/22/2022]
Abstract
To examine the expression of human telomere reverse transcriptase (hTERT), p53 and proliferating cell nuclear antigen (PCNA) in cystitis glandularis, 38 patients were divided into two groups: group A (including 18 cases of papillary cystitis glandularis) and group B (including 20 subjects with normal bladder mucosa). All the cases were immunohistochemically examined by using antibodies specifically against p53 and PCNA, and hTERT was determined by in situ hybridization. hTERT was found in 6 cases (33.3%) and p53 was detected in 4 cases (22.2%) in group A, while they were not detected in group B. There were significant differences in hTERT and p53 expression between groups A and B (P<0.05 for both). PCNA was detected in 7 cases (38.9%) in group A and 1 case (5.0%) in group B, and significant difference in PCNA expression was found between the two groups (P<0.05). The expressions of hTERT, p53 and PCNA were significantly higher in group A than in group B, suggesting that papillary cystitis glandularis is predisposed to cancerous change, and p53, PCNA, hTERT may be related to the malignant alteration.
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Affiliation(s)
- Zhifeng Wei
- Department of Urology, Nanjing General Hospital of Nanjing Military Command of PLA, Nanjing 210002, Jiangsu, China.
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15
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Williamson SR, Lopez-Beltran A, Montironi R, Cheng L. Glandular lesions of the urinary bladder:clinical significance and differential diagnosis. Histopathology 2010; 58:811-34. [DOI: 10.1111/j.1365-2559.2010.03651.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Affiliation(s)
- Robert H Young
- Pathology Service, Massachusetts General Hospital, Boston, MA 02114, USA.
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Recurrent villous adenoma with high-grade dysplasia arising in a urethral diverticulum. Case Rep Med 2009; 2009:361212. [PMID: 19718251 PMCID: PMC2729294 DOI: 10.1155/2009/361212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 04/01/2009] [Indexed: 01/26/2023] Open
Abstract
Villous adenomas of the urinary tract are an uncommon, well-recognized entity, described in different locations. However, the occurrence of this lesion in the female urethral diverticulum is very unusual. We present the first case of a recurrent villous adenoma with high-grade dysplasia unassociated with adenocarcinoma, arising from a urethral diverticulum. A 75-year-old African-American female presented with urethral prolapse complaining of mild voiding difficulty, stress incontinence, and mild spotting of blood. Histological examination revealed a papillary lesion with finger-like processes lined by pseudostratified columnar epithelium with abundant goblet cells. There were focal areas with stratification to the luminal surface and loss of nuclear polarity and atypical mitoses, interpreted as villous adenoma with high-grade dysplasia. The lesion
recurred at one year without evidence of malignant transformation. We also present a brief literature review of urothelial villous adenomas.
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20
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Abstract
Tumor-like lesions of the urinary bladder are reviewed emphasizing those that are most diagnostically challenging for the pathologist and may result in serious errors in patient care if misinterpreted. The first category considered, pseudocarcinomatous proliferations, represents an area of bladder pathology only recently appreciated as being particularly treacherous because of the extent to which irregular islands of benign epithelial cells may seemingly penetrate the lamina propria and cause confusion with carcinoma. Somewhat orderly proliferations of this type have been known for years, von Brunn's nests, and are rarely a challenge for the experienced, but proliferations of an irregular nature such as may be seen most often as a result of prior radiation therapy, but sometimes due to chemotherapy or even ischemia, represent a challenging interpretation. The clinical history may be very important in arriving at the correct diagnosis as is the appreciation that the morphology, although architecturally problematic, is different from that of any of the familiar patterns of invasive carcinoma. Florid epithelial proliferations in fibroepithelial polyps are also briefly noted. Within the category of glandular proliferations, emphasis is placed on the wide spectrum of morphology of nephrogenic adenoma including its pseudoinfiltrative pattern and occasional propensity for tiny tubules to be misconstrued as signet-ring cells. The spectrum of müllerian glandular lesions including the relatively recently described mucinous variant, endocervicosis, is reviewed. The reactive papillary proliferation, papillary-polypoid cystitis, is then discussed. This entity has long been known but has recently been re-emphasized. Other non-neoplastic papillary lesions include florid papillary forms of nephrogenic adenoma. The past 25 years has seen a great expansion of knowledge concerning non-neoplastic spindle cell proliferations, including those related to a prior procedure, the postoperative spindle cell nodule and those without such a history, variously designated inflammatory pseudotumor, pseudosarcomatous myofibroblastic proliferation, or even other terms. The morphologic spectrum is explored and it is recommended that the two categories be retained.
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21
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Horiuchi K, Ohgaki K, Sato M, Oka F, Nishimura T. A case of asymptomatic cystitis glandularis found incidentally with ultrasonography at a private clinic. J NIPPON MED SCH 2009; 75:347-9. [PMID: 19155573 DOI: 10.1272/jnms.75.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 46-year-old man was transferred to our hospital because of a bladder mass. The mass could not be distinguished from a primary bladder tumor or a tumor invading from another organ with computed tomography, magnetic resonance, or cystoscopic examination. Transurethral resection of the mass was performed, and the pathological diagnosis was typical cystitis glandularis. The patient has been followed up with cytologic examination and ultrasonography, and after 10 months there has been no new growth of the mass or malignant change.
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Affiliation(s)
- Kazutaka Horiuchi
- Department of Urologic Surgery, Graduate School of Medicine Nippon Medical School, Tokyo, Japan.
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22
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Shanks JH, Iczkowski KA. Divergent differentiation in urothelial carcinoma and other bladder cancer subtypes with selected mimics. Histopathology 2008; 54:885-900. [PMID: 19178589 DOI: 10.1111/j.1365-2559.2008.03167.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Conventional urothelial carcinoma accounts for most carcinomas of the urinary tract lining. However, neoplastic urothelium has the capacity to demonstrate enormous plasticity. A variety of unusual architectural patterns of urothelial carcinoma, such as the nested, microcystic and inverted variants, can be mistaken for reactive processes or benign tumours. Others such as the micropapillary, plasmacytoid and discohesive variants, can mimic metastatic tumour from other sites. The micropapillary variant in particular is more aggressive. In addition, urothelial carcinoma has a propensity to demonstrate divergent differentiation with glandular, squamous, small cell neuroendocrine, lymphoepithelioma-like, sarcomatoid or other elements. Pure squamous carcinoma or adenocarcinoma (the latter in particular) can be difficult to distinguish from contiguous or metastatic spread. Some variants have prognostic and potential therapeutic implications. Molecular genetic evidence has emerged recently supporting a close relationship between urothelial carcinoma and various divergent elements. Sarcomatoid carcinoma and its differential diagnosis with other spindle cell lesions of urinary tract will be covered in a separate review.
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Affiliation(s)
- J H Shanks
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK.
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23
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Coelho RF, Marchini GS, Dall’Oglio MF, de Medeiros MT, Nesrallah AJ, Srougi M. Cystoprostatectomy with ileal neobladder for treatment of severe cystitis glandularis in an AIDS patient. Clinics (Sao Paulo) 2008; 63:713-6. [PMID: 18925335 PMCID: PMC2664733 DOI: 10.1590/s1807-59322008000500023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rafael Ferreira Coelho
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
| | - Giovanni Scala Marchini
- Department of General Surgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
| | - Marcos Francisco Dall’Oglio
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
| | - Mabel Tatty de Medeiros
- Department of Pathology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil. Phone: 55 11 9450.2824,
| | - Adriano João Nesrallah
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
| | - Miguel Srougi
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
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24
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Touffahi M, Fredj N, Lefi M, Hafsa C, Hallara W, Moussa A, Saad H. [To analyse diagnosis, management and prognosis of florid cystitis glandularis (pseudoneoplastic entity)]. Prog Urol 2008; 17:968-72. [PMID: 17969799 DOI: 10.1016/s1166-7087(07)92399-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyse diagnosis, management and prognosis of florid cystitis glandularis (pseudoneplastic entity). PATIENTS AND METHODS A retrospective study of 6 consecutive patients with florid cystitis glandularis seen at the department of Urology of Monastir (Tunisia) from January 1996 to July 2006. All patients underwent ultrasonography, and cystoscopy. Computed tomography (CT) was performed in four patients and magnetic resonance imaging (MRI) in one patient. RESULTS The six patients, all of whom were male, ranged from 22 to 68 (average 42) years of age. The most common complaints was haematuria. Radiological examination and cystoscopy suggested a bladder tumor in all patients. Histopathology revealed features of cystitis glandularis of intestinal type. Features of the pelvic CT and MRI were consistent with the diagnosis of pelvic lipomatosis in one patient. The endoscopic resection was performed in 5 patients. Recurrence occurred in one of these 5 patients within one and 7 years of follow-up. The other patient had developed a low compliance small-capacity bladder and bilateral ureteral obstruction. A total cystoprostatectomy and ileal neobladder construction was considered, but it was declined by the patient. The patient was treated with anti-inflammatory drug (Indometacine 100 mg/day). CONCLUSION Cystitis glandularis may be mistaken for bladder tumor The diagnosis is histological. Treatment is based on eradication of the irritative factors and endoscopic resection of the tumoral masses. The clinical course is unclear, requiring long-term fellow-up.
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Affiliation(s)
- Mounir Touffahi
- Service d'urologie CHU Fattouma Bourguiba Monastir, Tunisie.
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25
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Distinguishing benign dissecting mucin (stromal mucin pools) from invasive mucinous carcinoma. Adv Anat Pathol 2008; 15:1-17. [PMID: 18156808 DOI: 10.1097/pap.0b013e31815e52aa] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mucin dissecting stroma suggests the presence of an invasive mucinous (colloid) carcinoma. However, in virtually every organ in which invasive mucinous carcinoma exists, there exist benign mimickers associated with dissecting mucin. This article reviews diagnostic criteria for the differential diagnosis of mucinous lesions of the breast, pancreas, biliary tract, colon, appendix, and bladder, emphasizing practical points, which we find helpful in daily diagnostic surgical pathology practice.
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26
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Jankovic Velickovic L, Katic V, Hattori T, Kushima R, Marjanovic G, Stefanovic V. Differences in the expression of mucins in various forms of cystitis glandularis. Pathol Res Pract 2007; 203:653-8. [PMID: 17659847 DOI: 10.1016/j.prp.2007.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 05/02/2007] [Accepted: 05/07/2007] [Indexed: 01/08/2023]
Abstract
A wide spectrum of glandular epithelial metaplastic changes may be seen in the bladder. Cystitis glandularis (CG) is a well-known metaplastic lesion occurring in the presence of chronic inflammation, but there are a few data about mucin expression in its two subtypes (typical and intestinal). The purpose of the present study was to determine the expression of mucin core proteins and CD10 in the different types of CG. For this examination, we used a panel of monoclonal-specific antibodies for MUC1, MUC2, MUC5AC, and MUC6. CG of the intestinal type expressed MUC5AC both in goblet and columnar cells, and strongly expressed intestinal mucin MUC2 only in goblet cells in all cases. There was no expression of MUC1, MUC6, and CD10 in the metaplastic cells. CG of the typical type showed an expression of MUC1 similar to normal urothelium, but the CD10 expression was more intensive than in the control. The mucin expression profile in the different types of CG allows the identification of "gastric mucin" (MUC5AC) together with intestinal mucin (MUC2), while typical CG (CGTP) retains MUC1. Different and contrasting immunoprofiles were evident in various forms of CG. The absence of CD 10 in CG of the intestinal type is a finding that points towards an incomplete form of urinary bladder metaplasia.
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27
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Kaya C, Akpinar IN, Aker F, Turkeri LN. Large Cystitis Glandularis: A Very Rare cause of Severe Obstructive Urinary Symptoms in an Adult. Int Urol Nephrol 2006; 39:441-4. [PMID: 17171414 DOI: 10.1007/s11255-006-9042-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 05/09/2006] [Indexed: 10/23/2022]
Abstract
Cystitis glandularis is a very rare proliferative disorder of the mucus-producing glands within the mucosa and submucosa of urinary bladder epithelium. We report such a case of glandular cystitis with intestinal metaplasia masquerading as a bladder tumor in a young male patient who presented with severe obstructive urinary symptoms. Cystoscopy revealed a tumor well circumscribed, measuring 5 x 4 cm on the trigone. Transurethral resection of the mass was carried out and the histopathology suggested cystitis glandularis. The literature regarding this entity has been reviewed and the differential diagnosis was discussed. Short-term follow-up of the patient with sonography and cystoscopy showed no recurrence.
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Affiliation(s)
- Cevdet Kaya
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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28
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Sung MT, Lopez-Beltran A, Eble JN, MacLennan GT, Tan PH, Montironi R, Jones TD, Ulbright TM, Blair JE, Cheng L. Divergent pathway of intestinal metaplasia and cystitis glandularis of the urinary bladder. Mod Pathol 2006; 19:1395-401. [PMID: 16951671 DOI: 10.1038/modpathol.3800670] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intestinal metaplasia has been proposed to be a precursor lesion of adenocarcinoma in the urinary bladder. CDX2 is a transcription factor that is encoded by a homeotype gene that plays an essential role in the differentiation and proliferation of intestinal epithelial cells. Hepatocyte-specific antigen (Hep) has also been shown to be a useful marker of intestinal metaplasia. Tissues from 46 patients, including 22 cases of intestinal metaplasia of the urinary bladder, 11 cases of typical cystitis glandularis, and 13 cases containing both lesions, were selected and immunohistochemical stains for CDX2, Hep, cytokeratin 20 (CK20), and cytokeratin 7 (CK7) were performed. Nuclear staining for CDX2 was observed in 29 of 35 (83%) cases of intestinal metaplasia of the urinary bladder. In contrast, nuclear staining for CDX2 was not observed in any case of typical cystitis glandularis; however, seven of 24 (29%) cases showed aberrant cytoplasmic expression in a mean of 37% of cells. CK20 was expressed in 28 of 35 (80%) cases of intestinal metaplasia, but was observed in only one of 24 (4%) cases of cystitis glandularis in 15% of cells. CK7 was expressed in only six of 35 (17%) cases of intestinal metaplasia, whereas expression of CK7 was observed in all cases (100%) of typical cystitis glandularis with a mean percentage of positively staining cells of 63%. The mean percentages of positively staining cells in intestinal metaplasia with CDX2, CK20, and CK7 were 55, 49, and 53%, respectively. All examples of both intestinal metaplasia and typical cystitis glandularis were uniformly negative for Hep. In the urinary bladder, intestinal metaplasia and typical cystitis glandularis have sharply contrasting immunoprofiles. Additionally, the absence of Hep staining in intestinal metaplasia of the urinary bladder, despite its morphologic resemblance to normal colonic mucosa and intestinal metaplasia in other organs, may signify the presence of unique metaplastic pathways in the urinary bladder.
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Affiliation(s)
- Ming-Tse Sung
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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29
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Affiliation(s)
- Bradley D Figler
- Department of Pathology and Urology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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30
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Black PC, Lange PH. Cystoprostatectomy and neobladder construction for florid cystitis glandularis. Urology 2005; 65:174. [PMID: 15667889 DOI: 10.1016/j.urology.2004.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 07/26/2004] [Indexed: 10/25/2022]
Abstract
Cystitis glandularis is a benign proliferative disease of the bladder mucosa with a characteristic histopathologic appearance. If a mass lesion is identified, it is resected transurethrally. More extensive surgical management for severe or recurrent cases is poorly characterized in published studies. We present a patient with multiple rapid recurrences of polypoid masses on the trigone causing irritative voiding symptoms. He developed a low-compliance small-capacity bladder and bilateral ureteral obstruction. The patient underwent total cystoprostatectomy with cavernosal nerve sparing and ileal neobladder construction. We advocate such aggressive surgical management in select cases of this disease.
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Affiliation(s)
- Peter C Black
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA
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31
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Mukhopadhyay S, Taylor W. Pathologic quiz case: bladder tumor in a 41-year-old man. Cystitis glandularis of intestinal type with mucin extravasation. Arch Pathol Lab Med 2004; 128:e89-90. [PMID: 15214835 DOI: 10.5858/2004-128-e89-pqcbti] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
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32
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Borda A, Petrucci MD, Berger N. Lésions bénignes diverses de la vessie et de la voie excréto urinaire. Ann Pathol 2004; 24:18-30; quiz 17. [PMID: 15192534 DOI: 10.1016/s0242-6498(04)93894-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Miscellaneous benign lesions of the bladder are composed of morphologic aspects of the urothelial mucosa. They are epithelial lesions (von Brunn nests, glandularis cystitis, nephrogenic adenoma, polypoid cystitis and epidermoid metaplasia), myofibroblastic proliferations and heterotopias (endometriosis, endocervicosis, endosalpingiosis and ectopic prostatic tissue). Etiology, morphologic aspects and differential diagnosis are discussed.
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Affiliation(s)
- Angela Borda
- Laboratoire d'Anatomie Pathologique, Université de Médecine et de Pharmacie de Targu-Mures, Roumanie
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33
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Bryan RT, Nicholls JH, Harrison RF, Jankowski JA, Wallace DMA. The role of beta-catenin signaling in the malignant potential of cystitis glandularis. J Urol 2003; 170:1892-6. [PMID: 14532801 DOI: 10.1097/01.ju.0000092740.51330.39] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Chronic inflammation is a risk factor for malignant transformation in the bladder. The pro-inflammatory cytokine tumor necrosis factor-alpha (TNFalpha) is a mediator of such inflammation that induces nuclear localization of the adherens junction component beta-catenin. This mechanism has a key role in the initiation and progression of the premalignant lesion Barrett's metaplasia of the esophagus. Cystitis glandularis is a metaplastic lesion of the bladder urothelium occurring in the presence of chronic inflammation and in up to 13% of asymptomatic bladders. Two subtypes are described (typical and intestinal/colonic) with uncertain malignant potential. Etiologically and histologically cystitis glandularis mimics Barrett's metaplasia. We investigated the roles of beta-catenin and TNFalpha in cystitis glandularis. MATERIALS AND METHODS Immunohistochemistry and immunofluorescence were used to demonstrate the expression and localization of E-cadherin, beta-catenin and TNFalpha in 9 sections of typical cystitis glandularis and 4 of intestinal/colonic cystitis glandularis. Appropriate controls were used for all experiments. RESULTS Immunohistochemistry demonstrated normal membranous expression of E-cadherin and beta-catenin in all cystitis glandularis sections with increased TNFalpha expression. Immunofluorescence showed nuclear localization of beta-catenin in the intestinal/colonic subtype only, which was not observed in typical cystitis glandularis. CONCLUSIONS The presence of nuclear beta-catenin suggests that intestinal/colonic cystitis glandularis shares the same signaling pathway with the premalignant lesion Barrett's metaplasia of the esophagus and the intestinal/colonic subtype of cystitis glandularis may have the potential to progress to malignancy. This finding has important implications for the management of this lesion.
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Affiliation(s)
- R T Bryan
- Epithelial Laboratory, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
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34
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Guarch Troyas R, Jiménez Calvo J, Reparaz Romero B, Gómez Dorronsoro ML. [Florid glandular cystitis of the intestinal type with mucin extravasation: a lesion simulating a tumor]. Actas Urol Esp 2003; 27:297-300. [PMID: 12830552 DOI: 10.1016/s0210-4806(03)72924-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A wide spectrum of glandular epitheliales metaplastic changes may be seen in the bladder. Extensive replacement of the urotelium with an epithelium resembling intestinal mucosa is recognised as a premalignant condition. However, the natural history of intestinal metaplasia of the urinary bladder and long-term outcome are unknown. We report a case of glandular cystitis with intestinal metaplasia in a young patient. Cystoscopy revealed a tumour well circumscribed measuring 4 cm on the trigone. Microscopic examination showed numerous glands lined by intestinal type epithelium without atipia, conforming to the appearance of the intestinal variant of cystitis glandularis. This case had prominent foci of basophilic mucin in the stroma. Rounded aggregates of mucin were occasionally surrounded by compressed connective tissue cells, simulating mucinous cyst. This case illustrates the extent to which cystitis glandularis may mimic a neoplasm on gross evaluation and the propensity of mucin extravasation to cause diagnostic difficulty, a finding documented only rarely previously, and we discuss its biologic significance.
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Affiliation(s)
- R Guarch Troyas
- Servicio de Anatomía Patológica, Hospital Virgen del Camino, Pamplona, Navarra
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35
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Chen Z, Lan R, Ye Z, Yang W. Analysis on pathogenesis of 50 cases of bladder proliferative lesions. Curr Med Sci 2003; 23:294-6. [PMID: 14526439 DOI: 10.1007/bf02829519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2002] [Indexed: 10/19/2022]
Abstract
In order to study the pathogenesis, clinical and pathological characteristics of proliferative lesions of the bladder, 50 cases of proliferative lesions of the bladder from 150 patients with complaints of frequency, urgency, hematuria and dysuria were subjected to cystoscopic biopsy of the suspicious foci in the bladder. In combination with the symptoms, urine and urodynamics, the relationship of proliferative lesions of the bladder to the inflammation and obstruction of the lower urinary tract was analyzed. Of the 50 cases of proliferative bladder lesions, 44 cases (88%) had lower urinary tract infection and 29 (58%) lower urinary tract obstruction. The patients with lower urinary tract obstruction were all complicated with infection. Three cases were associated with transitional cell carcinoma. Malignant cells were detected in 1 case by urinary cytologic examination. Proliferative lesions of the bladder, especially those without other obvious mucosa changes under cystoscopy, are common histological variants of urothelium in the patients with chronic inflammation and obstruction of the lower urinary tract. Chronic inflammation and obstruction of the lower urinary tract might be the causes for proliferative lesions of the bladder. It is suggested that different treatments should be applied according to the scope and histological type of the proliferative lesions.
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Affiliation(s)
- Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030
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36
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Abstract
In situ adenocarcinoma of the bladder has not been well studied. Only one other case not associated with infiltrating adenocarcinoma has been reported in the literature. We identified 19 biopsies of in situ adenocarcinoma of the bladder without concurrent infiltrating adenocarcinoma or villous adenoma from the surgical pathology files of the Johns Hopkins Hospital between May 1984 and July 2000. The majority of patients (89%) were seen in consultation. The mean age at diagnosis was 70.4 years (range 48-88 years) and 79% were male. None of the patients developed a pure infiltrating adenocarcinoma; however, two patients had invasive urothelial carcinoma with focal glandular differentiation on prior or subsequent specimens. Two cases were pure in situ adenocarcinoma and 10 were seen with carcinoma in situ and/or papillary transitional cell cancer without invasion. Most patients (74%) had invasive carcinoma on either concurrent or subsequent specimens (five small cell and nine transitional cell [four micropapillary]). The majority (84%) of in situ adenocarcinomas were papillary, often seen in combination with either cribriform or flat architecture. In most cases the in situ adenocarcinoma was the predominant component when it was present with another in situ urothelial carcinoma. Seventy-nine percent of in situ adenocarcinomas showed >5 mitoses/10 HPF and 42% showed >10 mitoses/10 HPF. Moderate to severe nuclear pleomorphism was seen in 84% of cases. All cases showed apoptosis, and only one case showed focal necrosis. Seven patients were treated with cystectomy within 2-12 months. Of the other 12 patients, 10 were followed for a mean of 19.3 months (range 1-62 months). Ten (52%) patients were treated with bacille Calmette-Guérin, of whom four had no residual tumor on subsequent biopsy or cystectomy specimens. Three patients developed metastatic disease. In situ adenocarcinoma is a rare lesion that has a high incidence of association with small cell and micropapillary transitional cell carcinomas. When identified, in situ adenocarcinoma may indicate subsequent development of specific types of prognostically poor invasive carcinomas.
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Affiliation(s)
- T Y Chan
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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37
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Abstract
A wide range of epithelial and mesenchymal pseudoneoplastic disorders of the urinary bladder may clinically and pathologically mimic a malignant neoplasm. These lesions usually require a tissue biopsy for definitive diagnosis. It is important to be aware of these lesions and their spectrum of morphologic appearances to avoid overdiagnosis and inappropriate aggressive therapy.
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Affiliation(s)
- E C Jones
- Department of Pathology, Vancouver General Hospital, University of British Columbia, Canada
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