Cystitis Cystica and Glandularis

Cystitis Cystica and Glandularis

Jesse K. McKenney, MD

This collection of glandular structures within the superficial lamina propria has overall lobularity and a sharp linear border at the base, features typical of cystitis glandularis.

On high-power examination, the glandular epithelium within the lamina propria has abundant luminally oriented cytoplasm, a feature that distinguishes cystitis glandularis from cystitis cystica.



  • Cystitis cystica

    • Invaginated urothelial nests in superficial lamina propria with cystic dilatation forming luminal space

    • No cuboidal or columnar luminal cells are present

  • Cystitis glandularis

    • Cystitis cystica with luminal cuboidal or columnar lining cells

  • Cystitis glandularis with intestinal metaplasia (intestinal type)

    • Cystitis glandularis with at least focal intestinal-type goblet cells


Environmental Exposure

  • May be secondary to localized inflammatory response

  • May be a variation in normal bladder microanatomy



  • Usually incidental finding

  • When florid, small raised lesion with intact urothelium may be seen

  • Rare cases with intestinal metaplasia and extensive mucin extravasation may form large mass lesion that can mimic malignancy


  • None


  • No convincing evidence that cystitis cystica or glandularis represents neoplastic precursor lesion


General Features

  • May form polypoid mass in some florid examples

    • Intact overlying mucosa with variable translucent appearance

  • Usually < 1 cm


Histologic Features

  • Cystitis cystica

    • Superficial nests of invaginated urothelium in lamina propria

      • Connection to surface urothelium is variable

      • May be organized into lobules

      • In contrast to von Brunn nests, have cystically dilated lumen

      • No glandular-lining cells are present

      • Often admixed with von Brunn nests

  • Cystitis glandularis

    • Identical to cystitis cystica, except glandular cells line central lumen

      • Cuboidal or columnar cells with luminally oriented cytoplasm

  • Cystitis glandularis with intestinal metaplasia

    • Identical to cystitis glandularis with at least scattered intestinal-type goblet cells

    • Rare cases may have extensive mucin extravasation

      • No significant cytologic atypia

      • No irregular epithelial aggregates

      • No destructive invasion of muscularis propria


Invasive Adenocarcinoma

  • Usually high stage with destructive invasion into muscularis propria

  • Greater degree of nuclear atypia

  • In mucinous (colloid) variant, epithelium forms irregular aggregates within stromal mucin

    • Distinctive feature from cystitis glandularis with mucin extravasation

Noninvasive Urothelial Carcinoma with Glandular Differentiation (Adenocarcinoma In Situ)

  • Exophytic papillary urothelial carcinoma component may be present

  • Glandular component has more atypia than cystitis cystica

    • Columnar cells with nucleomegaly, hyperchromasia, and mitotic activity

  • May also have complex exophytic papillary glandular pattern

Nested Urothelial Carcinoma with Associated Tubules

  • Individual nests may have significant overlap with cystitis cystica on superficial biopsy

    • Have subtle nucleomegaly

  • Typically extends deeply into lamina propria or muscularis propria

    • Invasive clusters may have surrounding retraction

Prostatic-Type Polyp

  • Glands within stroma have prostatic secretory phenotype

    • Lightly eosinophilic, frothy cytoplasm

    • Round nuclei

    • PSA and PAP positive

Inverted Urothelial Papilloma

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Cystitis Cystica and Glandularis
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