Cystitis Cystica and Glandularis



Cystitis Cystica and Glandularis


Jesse K. McKenney, MD





Key Facts


Terminology



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


  • Cystitis glandularis has luminal cuboidal or columnar lining cells


  • Cystitis glandularis of intestinal type contains goblet cells


Etiology/Pathogenesis



  • May be normal variant or secondary to localized inflammatory response


Clinical Issues



  • Usually incidental finding


  • When florid, may have polypoid appearance clinically


  • No convincing evidence of neoplastic precursor lesion


Microscopic Pathology



  • Cystitis cystica has superficial nests of urothelium with central cysts


  • Glandular cells line central lumen in cystitis glandularis


  • Cystitis glandularis with intestinal metaplasia contains goblet cells


  • Rare cases have extensive mucin extravasation


Top Differential Diagnoses



  • Invasive adenocarcinoma


  • Noninvasive urothelial carcinoma with glandular differentiation (adenocarcinoma in situ)


  • Nested urothelial carcinoma with associated tubules







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.


TERMINOLOGY


Definitions



  • 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


ETIOLOGY/PATHOGENESIS


Environmental Exposure



  • May be secondary to localized inflammatory response


  • May be a variation in normal bladder microanatomy


CLINICAL ISSUES


Presentation



  • 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


Treatment



  • None


Prognosis



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


MACROSCOPIC FEATURES


General Features



  • May form polypoid mass in some florid examples



    • Intact overlying mucosa with variable translucent appearance


  • Usually < 1 cm


MICROSCOPIC PATHOLOGY


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


DIFFERENTIAL DIAGNOSIS


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

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

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