Eosinophilic cystitis simulating invasive bladder carcinoma

The Spectrum of Eosinophilic Cystitis in Males: Case Series and Literature Review

Context.—Eosinophilic cystitis (EC) is an inflammatory condition of the bladder that has been linked to food allergens, infectious agents, drugs, and other genitourinary conditions. Like interstitial cystitis, EC has a strong female predominance. It is characterized by an intense eosinophilic infiltrate in the acute phase and fibrosis in the chronic phase.

Objectives.—To document and focus on specific features of EC in males and highlight the relationship between clinical and histopathologic findings.

Design.—The bladder biopsies of male patients were reviewed. Eight cases of EC were selected.

Results.—Several known associations were noted as well as unreported features and associations such as Charcot-Leyden crystals, celiac disease, lupus anticoagulant, and additional viral and bacterial agents.

Conclusions.—Eosinophilic cystitis represents a response to a variety of agents and may often be overlooked. The temporally biphasic morphologic features are the hallmark of this condition. Because clinical and imaging studies are not specific, a high index of clinical suspicion is often crucial to the correct diagnosis and proper management of EC.

Eosinophilic cystitis simulating invasive bladder cancer: a real diagnostic challenge

OBJECTIVES

To report our experience with eosinophilic cystitis (EC) presented as invasive bladder cancer.

MATERIALS AND METHODS

We recently treated three patients with bladder masses mimicking neoplasms and biopsy proved the diagnosis of EC. Data from our three patients were presented.

RESULTS

There were two females and one male with ages of 14, 43 and 38 years. All the three patients had irritative bladder symptoms, suprapubic pain and hematuria. Bladder mass was detected by pelvic examination in the three patients and confirmed by radiologic tests and cystoscopy. In one patient, the mass caused bilateral hydroureteronephrosis while the upper tract was normal in the other two. Elevated serum leukocytes was evident in the three cases while peripheral eosinophilia was observed in one. Biopsy showed EC in all the three patients who were treated by transurethral resection of the lesions followed by a combination of corticosteroids, antibiotics and antihistaminics. All patients experienced marked improvement during a follow-up duration up to 30 months.

CONCLUSION

EC is a rare disease. In addition to symptoms of frequency, dysuria, hematuria and suprapubic pain, the disease may present with a bladder mass mimicking invasive bladder cancer. Resection of the lesion is mandatory with systemic treatment of corticosteroids, antihistaminics and antibiotics. Early detection and prompt treatment usually result in a good prognosis.

[Bladder fibrosis caused by eosinophilic cystitis]

A 70-years-old man with no history of allergy or genitourinary problems had bilateral hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic infiltration with fibrosis of the bladder wall. A total cystoprostatectomy with ileal bladder replacement was performed. We reviewed the literature of eosinophilic cystitis for clinical presentation, diagnosis and therapeutic options.

Eosinophilic cystitis--diagnosis and treatment in Denmark

OBJECTIVE

The purpose of this study was to evaluate the incidence, diagnostic criteria and treatment of eosinophilic cystitis (EC) in Denmark during the period 1989-94.

MATERIAL AND METHODS

A questionnaire was sent to all Danish departments of surgery, urology and pathology.

RESULTS

Fifty-six cases of EC were diagnosed in the departments of surgery and urology, and 135 patients were diagnosed in the departments of pathology. The therapy was most often steroid instillation in the bladder or peroral antihistamines. Success rates of treatment were reported to be acceptable.

CONCLUSION

The questionnaire confirmed that EC is a rare disease, which is often confused with other bladder diseases. We recommend strict histological criteria combined with clinical information when making the diagnosis of EC. Therapy is generally symptomatic. A diagnostic code number from the Danish Health Board is needed.

Endoscopic treatment of eosinophilic cystitis

Since 1990 we have treated 11 cases of eosinophilic cystitis. All patients were adult or elderly men with an average age of 66.4 years (range 46–83). Seven patients had previous superficial bladder cancer and 5 of these were treated with instillations of mitomycin C. Three patients were hospitalized following repeated episodes of macrohematuria. One case had peritonitis due to spontaneous rupture of the bladder. Cystoscopy showed hyperemic areas in all patients, mamillated areas in 7 cases and ulcerated and necrotic areas in 2 cases. The bladder mucosa appeared bloody in one patient. In nine cases multiple biopsies and wide fulguration of involved areas were performed. Two patients were submitted to complete resection of the lesions. The pathological examination documented an infiltration of eosinophils into the mucosa and lamina propria in all cases; in one of these the infiltration involved the muscularis. The patients have been followed for 24.5 months (range 13–37), with periodic cystoscopy and bladder biopsies. We have not documented recurrences of eosinophilic cystitis. Although the treatment of eosinophilic cystitis is controversial, our experience with diathermic fulguration or transurethral resection has proved effective with minimal invasiveness.