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Htoo A, George RS, Mian BM, Akgul M. Correlation of urinary catheterization with histologic grading of eosinophilic cystitis: a single institutional review of 27 cases. Acad Pathol 2023; 10:100078. [PMID: 37101897 PMCID: PMC10123339 DOI: 10.1016/j.acpath.2023.100078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 04/28/2023] Open
Abstract
Eosinophilic cystitis (EC) is an uncommon diagnosis, mimicking urothelial carcinoma. Multiple etiologies including iatrogenic, infectious, and neoplastic have been suggested, effecting both adults and pediatric population. A retrospective clinicopathologic review of patients with EC in our institution between 2003 and 2021 was conducted. Age, gender, presenting symptoms, cystoscopic findings, and history of urinary bladder instrumentation were recorded. Histologically, urothelial and stromal changes were noted, and mucosal eosinophilic infiltration was graded as mild (scattered eosinophils in the lamina propria), moderate (visible small clusters of eosinophils without brisk reactive changes), or severe (dense eosinophilic infiltrate with ulcer formation and/or muscularis propria infiltration). Twenty-seven patients (male to female ratio = 18/9, median age 58 [12-85 years]), of whom two were in the pediatric age group were identified. Leading presenting symptoms were hematuria (9/27, 33%), neurogenic bladder (8/27, 30%), and lower urinary tract symptoms (5/27, 18%). Four of 27 (15%) patients had history of urothelial carcinoma of urinary bladder. Cystoscopy commonly revealed erythematous mucosa (21/27, 78%) and/or urinary bladder mass (6/27, 22%). Seventeen of 27 (63%) of patients had history of long-term/frequent catheterization. Mild, moderate, and severe eosinophilic infiltrates were seen in 4/27 (15%), 9/27 (33%), and 14/27 (52%) of cases. Proliferative cystitis (19/27, 70%) and granulation tissue (15/27, 56%) were additional common findings. All cases of long-term/frequent instrumentation cases had moderate or severe eosinophilic infiltrate. EC should be in the differential diagnosis; particularly in patients with long term/frequent catheterization.
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Affiliation(s)
- Arkar Htoo
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Rose S. George
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Badar M. Mian
- Department of Surgery in the Division of Urology at Albany Medical College, Albany, NY, USA
| | - Mahmut Akgul
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
- Corresponding author. Department of Pathology and Laboratory Medicine, Albany Medical Center, 47 New Scotland Avenue, Albany, NY, 12208, USA.
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2
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El-Ghar MA, Farg H, Sharaf DE, El-Diasty T. CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010032. [PMID: 33401464 PMCID: PMC7824127 DOI: 10.3390/medicina57010032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques—including both computed tomography (CT) and magnetic resonance imaging (MRI)—have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis.
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3
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Chehroudi C, Afshar K. Case: Spontaneous bladder rupture presenting as sudden-onset abdominal pain in a child after many years in remission from bladder rhabdomyosarcoma. Can Urol Assoc J 2017; 12:E34-E36. [PMID: 29173271 DOI: 10.5489/cuaj.4671] [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
Bladder rupture in the absence of trauma (spontaneous bladder rupture) is a rare but life-threatening phenomenon, commonly associated with pelvic malignancy1,2 and postvaginal delivery.3 In children, case reports of spontaneous bladder rupture are most often idiopathic or associated with congenital genitourinary malformations (e.g., posterior urethral valve) and bladder augmentation surgery.4 Since bladder rupture often presents with acute abdominal pain, the diagnosis can be missed, leading to delayed treatment and poor outcomes. Here, we describe the second case in the literature, to our knowledge, of spontaneous bladder rupture in a pediatric patient with prior bladder rhabdomyosarcoma.
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Affiliation(s)
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia; Vancouver, BC, Canada
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4
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Shelmerdine SC, Lorenzo AJ, Gupta AA, Chavhan GB. Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses. Radiographics 2017; 37:1872-1891. [DOI: 10.1148/rg.2017170031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Susan C. Shelmerdine
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Armando J. Lorenzo
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Abha A. Gupta
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Govind B. Chavhan
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
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5
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Zhou AG, Amin A, Yates JK, Diamond DA, Tyminski MM, Badway JA, Ellsworth PI, Aidlen JT, Owens CL. Mass Forming Eosinophilic Cystitis in Pediatric Patients. Urology 2016; 101:139-141. [PMID: 27840250 DOI: 10.1016/j.urology.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 11/15/2022]
Abstract
Eosinophilic cystitis (EC) is an uncommon inflammatory disorder of uncertain etiology that has been described in adult and pediatric populations. We describe 3 recent cases of EC that presented as a mass lesion in pediatric patients from the New England region of the United States. All patients were initially suspected to have a malignancy, and biopsy was performed, which ultimately led to the diagnosis of EC. We propose the use of eosinophil density of >25 eosinophils per high-power field and myocyte degeneration as supportive histopathologic features to make this diagnosis. It is of utmost importance to consider EC in the differential diagnosis when approaching a pediatric patient with a bladder mass.
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Affiliation(s)
- Amy G Zhou
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA.
| | - Ali Amin
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI
| | - Jennifer K Yates
- Department of Urology, University of Massachusetts Medical School, Worcester, MA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Boston, MA
| | - Monique M Tyminski
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA
| | - Joseph A Badway
- Department of Urology, Boston Children's Hospital, Boston, MA
| | - Pamela I Ellsworth
- Department of Urology, University of Massachusetts Medical School, Worcester, MA
| | - Jeremy T Aidlen
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Christopher L Owens
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA
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6
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Li G, Cai B, Song H, Yang Z. Clinical and radiological character of eosinophilic cystitis. Int J Clin Exp Med 2015; 8:533-539. [PMID: 25785027 PMCID: PMC4358482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/13/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE Eosinophilic cystitis (EC) is a rare disease and remains a poorly understood. We explored the potential etiology, clinical and radiological presentation, diagnosis and therapeutic experience with EC. MATERIALS AND METHODS A pooled ten patients diagnosed with EC were retrospectively studied in our hospital to assess clinical presentation symptoms, radiological and pathological diagnosis, treatment and outcomes between 1998 and 2012. RESULTS Nine patients presented with irritative urinary symptoms, one was symptomless. Allergic history were found in 2 patients, bladder mass was detected in all by radiologic tests or cystoscopy. Radiology revealed diffuse thickening of bladder wall in 7 cases among which one with bilateral hydroureteronephrosis, solitary tumor-like lesion in other 3. Elevated serum leukocytes were evident in 4 cases while elevated peripheral eosinophilias were observed in 3. One was asymptomatic and without specific therapy (group 1, 10%), transurethral resection of the lesions in one tumor-like case (10%). The other 8 cases were treated with corticosteroid and/or antihistaminics and 5 patients had excellent outcome with symptom resolution (62.5%). CONCLUSIONS EC usually follows a benign course, most treated with corticosteroids and resulted in relief of symptoms while some may relapse. Surgery is an available choice for drug refractory or localized EC.
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Affiliation(s)
- Gang Li
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of UrologyTianjin 300211, China
| | - Bing Cai
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical CollegeWenzhou 32500, China
| | - Hualin Song
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of UrologyTianjin 300211, China
| | - Zhi Yang
- Department of Ultrasound, Binzhou Medical University HospitalBinzhou, Shandong Province 256600, China
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7
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Claps A, Della Corte M, Gerocarni Nappo S, Francalanci P, Palma P, Finocchi A. How should eosinophilic cystitis be treated in patients with chronic granulomatous disease? Pediatr Nephrol 2014; 29:2229-33. [PMID: 25037864 DOI: 10.1007/s00467-014-2883-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is a primary immunodeficiency resulting from the absence or malfunction of oxidative mechanism in phagocytic cells. The disease is due to a mutation in one of four genes that encode subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. Affected patients experience severe infections and granuloma formation due to exuberant inflammatory responses. Some evidence suggests that eosinophilic cystitis (EC) is included in the spectrum of inflammatory manifestations. EC is an inflammatory disease, rare in childhood, which may require different, nonstandardized therapeutic approaches, ranging from antihistamines to cyclosporine. CASE-DIAGNOSIS/TREATMENT Herein we describe the cases of two CGD patients with CGD who experienced EC during hospitalization for a severe infection. CONCLUSIONS EC in immunocompetent children seems to have a self-limiting course, unlike in CGD patients, in whom it presents a prolonged and recurrent course. We focus on the effective therapy administered to our patients with CGD and review the corresponding literature.
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Affiliation(s)
- Alessia Claps
- Unit of Immunology and Infectious Diseases, University-Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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8
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D M, T M K, M S, V R M, V G. Eosinophilic cystitis mimicking bladder tumour - a rare case report. J Clin Diagn Res 2013; 7:2282-3. [PMID: 24298501 DOI: 10.7860/jcdr/2013/6018.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/01/2013] [Indexed: 11/24/2022]
Abstract
A 16-year-old male presented with urinary urgency, a frequency of 4 months duration and intermittent gross haematuria which were there since one month. Eosinophilia was noted in complete blood count and CT KUB with contrast showed a filling defect in the right lateral wall, over the vesicoureteric junction. Cystoscopy revealed a sessile mass lesion over right vesico-ureteric junction, with bullous oedema . Rest of the mucosa was normal. Transurethral resection of lesion was performed and histological examination showed features of eosinophilic cystitis. Patient was treated with corticosteroids, antimicrobial agents and antihistaminics and he is recovering well. We are presenting this case for its rare presentation and its possibility of mimicking a bladder tumour. Biopsy of the lesion was diagnostic and an early treatment showed good results.
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Affiliation(s)
- Manimaran D
- Associate Professor, Department of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research , Tamilnadu, India
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9
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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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10
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Kojima K, Maeda J, Mikami S, Yamagishi H, Ide H, Hattori S, Takahashi T, Awazu M. Eosinophilic cystitis presented as a manifestation of hypereosinophilic syndrome: a case report and review of the literature. NEPHRON EXTRA 2013; 3:30-5. [PMID: 23573073 PMCID: PMC3618051 DOI: 10.1159/000346713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypereosinophilic syndrome (HES) is a group of disorders marked by the sustained overproduction of eosinophils, in which eosinophilic infiltration and inflammatory substance release cause damage to multiple organs. Eosinophilic cystitis (EC) is an inflammatory disorder caused by eosinophilic infiltration of the bladder wall. Although EC is often associated with eosinophilia, it has been rarely reported as a manifestation of HES. We report a case of EC as a primary manifestation of HES. The patient was a 27-year-old male with a history of complete intracardiac repair of tetralogy of Fallot who presented with an acute onset of dysuria accompanied by eosinophilia (7.5 × 10(3)/μl, 60% of white blood cells). Ultrasonography and MRI of the bladder showed a bladder mass, a biopsy of which revealed eosinophilic infiltration and degranulation. METHODS We performed a literature search in PubMed from 2001 to 2012 to find patients with EC who may have had HES. RESULTS There were 4 patients with HES who had EC including the present case. Of 14 patients reported as EC in whom the eosinophil count was described, 5 had eosinophils of ≥1,500/μl. None of the 5 patients had secondary causes for eosinophilia. Of the 9 patients with definite or probable HES, 7 patients (78%) were male and 5 patients (56%) showed a concomitant eosinophilic gastrointestinal disorder. CONCLUSION HES may not be uncommon as the cause of EC. Thorough evaluation and close monitoring are warranted in EC patients with elevated eosinophils.
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Affiliation(s)
- Katsuaki Kojima
- Department of Pediatrics, School of Medicine, Keio University, Tokyo, Japan
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11
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Abilov A, Ozcan R, Polat E, Dervişoğlu S, Emir H. Rare cause of dysuria: eosinophilic cystitis. J Pediatr Urol 2013; 9:e6-8. [PMID: 22652390 DOI: 10.1016/j.jpurol.2012.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
Eosinophilic cystitis is an inflammatory condition characterized by eosinophilic infiltration of whole layers of the bladder wall. The condition occurs more commonly in adults. We report a case of eosinophilic cystitis mimicking a bladder tumor in a 5-year-old boy with symptoms of dysuria and urinary incontinence. The diagnosis was confirmed by histopathology and he underwent clinical treatment with trimethoprim-sulfamethoxazole and antihistamine (cetirizine). The symptoms fully resolved in follow up, which is continuing. Although very rare, eosinophilic cystitis should be considered in cases of dysuria and increased bladder wall thickness but no identified urinary tract infection.
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Affiliation(s)
- Agil Abilov
- Division of Pediatric Urology, Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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12
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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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13
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Rossi E, Pavanello P, Marzola A, Franchella A. Eosinophilic cystitis and nephrogenic adenoma of the bladder: a rare association of 2 unusual findings in childhood. J Pediatr Surg 2011; 46:e31-e34. [PMID: 21496523 DOI: 10.1016/j.jpedsurg.2010.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/28/2010] [Accepted: 12/29/2010] [Indexed: 11/16/2022]
Abstract
Neither eosinophilic cystitis nor nephrogenic adenoma is often diagnosed in children, with few pediatric cases being reported in the literature. Although these maladies share the same predisposing conditions, namely, chronic irritation or injury to the urothelium and lower urinary tract and symptoms such as dysuria, hematuria, and urinary frequency, their concomitance is exceptional. Herein, we report the case of an 8-year-old boy with a previous history of bladder surgery presenting histologically diagnosed eosinophilic cystitis and nephrogenic adenoma.
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Affiliation(s)
- Enrica Rossi
- Pediatric Surgery Department, Sant'Anna Hospital, Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
| | - Piero Pavanello
- Pediatric Surgery Department, Sant'Anna Hospital, Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
| | - Andrea Marzola
- Institute of Pathology, University of Ferrara, Via Fossato di Mortara, 64, 44100 Ferrara, Italy.
| | - Andrea Franchella
- Pediatric Surgery Department, Sant'Anna Hospital, Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
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14
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Galutira PJT, Canonigo BB, Cabansag MRF, Bolong DT, Ong RC, Lopez RA. Presenting manifestations of eosinophilic cystitis in two Filipino children. Int Urol Nephrol 2009; 42:557-63. [PMID: 19866369 DOI: 10.1007/s11255-009-9665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 10/02/2009] [Indexed: 11/27/2022]
Abstract
Eosinophilic cystitis is a very rare clinical disease entity in the pediatric population. We report two cases of Filipino children with eosinophilic cystitis who presented with irritative voiding symptoms, gross hematuria, peripheral eosinophilia, and hydroureteronephrosis and urinary bladder wall thickening visualized on ultrasonography and CT urography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Both patients were started with corticosteroid with or without an antihistamine. Resolution from the signs and symptoms were observed in both patients as documented by disappearance of peripheral eosinophilia, normal urinalysis results, and resolution of the hydroureteronephrosis and urinary bladder wall thickening on ultrasonography on follow-up.
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Affiliation(s)
- Paul Joseph T Galutira
- Section of Pediatric Nephrology, University of Santo Tomas Hospital, Manila, Philippines.
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15
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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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16
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Evason MD, Carr AP. Eosinophilic cystitis in a female German wire-haired pointer. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2007; 48:509-11. [PMID: 17542370 PMCID: PMC1852600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A 7-month-old, intact female, German wire-haired pointer presented with a 3-week history of stranguria, pollakiuria, and dysuria that was nonresponsive to antibiotics. Two prior episodes of dysuria-stranguria appeared to respond to antibiotic therapy. Bladder wall biopsies revealed eosinophilic cystitis and the dog responded well to medical management.
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Affiliation(s)
- Michelle D Evason
- Small Animal Clinical Sciences Department, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4.
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17
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Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ. From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics 2006; 26:1847-68. [PMID: 17102055 DOI: 10.1148/rg.266065126] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although the vast majority of bladder tumors are epithelial neoplasms, a variety of nonneoplastic disorders can cause either focal bladder masses or diffuse mural thickening and mimic malignancy. Some of these entities are rare and poorly understood such as inflammatory pseudotumor, which produces ulcerated, bleeding polypoid bladder masses. These masses may be large and have an extravesical component. Bladder endometriosis manifests as submucosal masses with characteristic magnetic resonance imaging features consisting of hemorrhagic foci and reactive fibrosis. Nephrogenic adenoma has no typical features, and pathologic evaluation is required for diagnosis. Although imaging features of malacoplakia are also nonspecific, characteristic Michaelis-Gutmann bodies are found at pathologic evaluation. The various types of cystitis (cystitis cystica, cystitis glandularis, and eosinophilic cystitis) require pathologic diagnosis. Bladder infection with tuberculosis and schistosomiasis produces nonspecific bladder wall thickening and ulceration in the acute phase and should be suspected in patients who are immunocompromised or from countries where these infections are common. The diagnosis of chemotherapy cystitis and radiation cystitis should be clinically evident, but imaging may be used to determine severity and to assess complications. Extrinsic inflammatory diseases such as Crohn disease and diverticulitis may be associated with fistulas to the bladder and focal bladder wall abnormality. The extravesical findings allow the diagnosis to be made easily. Finally, extrinsic masses arising from the prostate or distal ureter may cause filling defects, which can be confused with intrinsic bladder masses.
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Affiliation(s)
- Jade J Wong-You-Cheong
- Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201-1595, USA.
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18
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Thompson RH, Dicks D, Kramer SA. Clinical manifestations and functional outcomes in children with eosinophilic cystitis. J Urol 2006; 174:2347-9. [PMID: 16280840 DOI: 10.1097/01.ju.0000180423.06285.72] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Eosinophilic cystitis is a rare disorder, with fewer than 30 pediatric cases reported in the literature. We describe our experience with pediatric eosinophilic cystitis during a 20-year period. MATERIALS AND METHODS Four children referred to our institution were subsequently diagnosed with eosinophilic cystitis between 1984 and 2004. A retrospective chart review was performed to assess clinical presentation, diagnosis, treatment and outcomes. RESULTS Mean patient age at presentation was 10.8 years (range 5 to 18) and male-to-female ratio was 3:1. All 4 patients presented with irritative urinary symptoms, including 3 with dysuria and/or gross hematuria and 2 with urinary frequency, lower abdominal pain and/or a concomitant urinary tract infection. Allergic diseases (asthma, allergic rhinitis, etc) were present in 3 patients, and a formal allergen skin test was positive in 2 of those tested. A bladder mass mimicking malignancy was documented in 2 patients. Three patients had symptom resolution with conservative treatment, while 1 had development of an unremitting tumefactive process that eventually required partial cystectomy and bladder augmentation. CONCLUSIONS Eosinophilic cystitis is a rare condition with a wide range of clinical manifestations. Children can present with a bladder mass mimicking sarcoma, underscoring the need for biopsy before diagnosis and treatment of a presumed oncological process. The condition usually follows a benign course, although unremitting progression remains a possibility.
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Affiliation(s)
- R Houston Thompson
- Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Eosinophilic cystitis is a rare inflammatory disorder. It is considered to be self limiting necessitating only supportive therapy. Surgical intervention is unusual. We report here an association between eosinophilic cystitis and anorexia nervosa in an adult woman requiring radical surgery for progressive relentless disease. Estrogen deficiency associated with a possible allergic etiology could explain this association.
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Affiliation(s)
- Joe Philip
- Department of Urology, Wirral Hospitals NHS Trust, Wirral, UK.
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20
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Hwang EC, Kwon DD, Kim CJ, Kang TW, Park K, Ryu SB, Ma JS. Eosinophilic cystitis causing spontaneous rupture of the urinary bladder in a child. Int J Urol 2006; 13:449-50. [PMID: 16734871 DOI: 10.1111/j.1442-2042.2006.01320.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a unique case of eosinophilic cystitis causing intraperitoneal bladder perforation in a child diagnosed by chance with no signs or history of trauma. To our knowledge, this is the first case of eosinophilic cystitis complicated by bladder rupture in children. The patient was successfully treated with primary repair. For children with non-traumatic bladder perforation, eosinophilic cystitis must be considered in the differential diagnosis.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Affiliation(s)
- Osama Al-Omar
- Department of Pediatric Urology, Wayne State University, Detroit, Michigan, USA
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22
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Lauder AJ, Jolin HE, Smith P, van den Berg JG, Jones A, Wisden W, Smith KGC, Dasvarma A, Fallon PG, McKenzie ANJ. Lymphomagenesis, hydronephrosis, and autoantibodies result from dysregulation of IL-9 and are differentially dependent on Th2 cytokines. THE JOURNAL OF IMMUNOLOGY 2004; 173:113-22. [PMID: 15210765 DOI: 10.4049/jimmunol.173.1.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Interleukin-9 is an immunoregulatory cytokine implicated in the development of asthma and allergy. To investigate the role of IL-9 in vivo, we have generated transgenic mice in which IL-9 is expressed from its own promoter. Strikingly, overexpression of IL-9 resulted in premature mortality associated with a complex phenotype characterized by the development of autoantibodies, hydronephrosis, and T cell lymphoma. By intercrossing IL-9 transgenic mice with a panel of Th2 cytokine-deficient mice, we demonstrate that these disorders represent distinct phenotypes that can be dissociated by their differential dependence on Th2 cytokines. Autoantibody production was ablated in IL-9 transgenic animals with a combined absence of IL-4, IL-5, and IL-13, coincident with a reduction in peritoneal B-1 cells. Hydronephrosis arose in 75% of IL-9 transgenic animals and was dependent on the presence of IL-4 and IL-13. In contrast, T cell lymphomas developed independently of the other Th2 cytokines, with the generation of rapidly proliferating CD8(+) or CD4(+)CD8(+) T cell clones that arose in the thymus before infiltrating both lymphoid and nonlymphoid tissues. Our data highlight potentially important new roles for IL-9, through its regulation of downstream Th2 effector cytokines, in autoantibody production and in hydronephrosis.
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Affiliation(s)
- Angus J Lauder
- Medical Research Council Laboratory of Molecular Biology, Hills Road, Cambridge CB2 2QH, United Kingdom
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23
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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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Kiliç S, Erguvan R, Ipek D, Gökçe H, Güneş A, Aydin NE, Baydinç C. Eosinophilic Cystitis. Urol Int 2003; 71:285-9. [PMID: 14512650 DOI: 10.1159/000072680] [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: 05/28/2002] [Accepted: 11/06/2002] [Indexed: 11/19/2022]
Abstract
PURPOSE We present a large series of eosinophilic cystitis including 8 cases; 3 of them had tumor-like lesions. MATERIALS AND METHODS The archives of pathology clinic of Inonu University Medical Faculty were reviewed from 1988 to 2002. The characteristics of patients and their diseases were recorded. Data obtained from 180 cases (172 from the literature and 8 from the present series) was assessed. RESULTS Seven cases had symptoms such as dysuria, frequency, hematuria, suprapubic pain, and difficulty in voiding. One asymptomatic case with history of bladder carcinoma was diagnosed during routine cystoscopy. The findings were microhematuria in 6 cases, macrohematuria in 2, pyuria in 3, urinary infection in 1, eosinophilia in 1, hyperazotemia in 1, and bladder masses in 3. Cystoscopies detected edematous and erythematous areas in 5 cases and lesions mimicking bladder carcinoma in 3. One case did not take further treatment after cystoscopy and biopsy and completely recovered. Four cases underwent medical therapy with nonsteroidal anti-inflammatory drugs and antihistaminics. They became asymptomatic and control cystoscopies showed no abnormal finding. Two of three patients with mass lesions recovered after steroid therapy following transurethral resection. The lesion in the third recurred and he improved after a second course of steroid therapy. CONCLUSIONS Eosinophilic cystitis is a rare pathology. Sometimes, it may simulate bladder malignancies. Biopsy is mandatory at diagnosis. Usually, it has a benign course and may be treated with fulguration, analgesics, antihistaminics and steroids, although recurrence is possible.
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Affiliation(s)
- Süleyman Kiliç
- Department of Urology, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, Turkey.
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