Cystitis Cystica and Cystitis Glandularis

Excerpt

Cystitis cystica is a common benign condition of the urinary bladder with a reactive inflammatory change of the bladder mucosa associated with subepithelial vesicles or cysts formation and glandular metaplasia (cystitis glandularis). Invaginations of hyperplastic urothelial extensions into the superficial lamina propria are called von Brunn nests. These inflammatory projections are considered reactive but benign and non-malignant.

Cystitis cystica develops when the urothelial cells in the lumens of von Brunn nests degenerate, causing cystic changes. Additional metaplasia results in cystitis glandularis, characterized by mucin-producing goblet cells that may uncommonly progress to vesical adenocarcinoma. Cystitis glandularis is a further proliferative progression of cystitis cystica characterized by glandular metaplasia of the urothelium and goblet cells.

Cystitis cystica and cystitis glandularis occur mainly in response to chronic irritation or inflammation and may occur together. They are usually asymptomatic but may present with non-specific signs and symptoms that require thoughtful attention to exclude other morphologically similar malignant lesions such as bladder adenocarcinoma. A nephrogenic adenoma is a rare, benign bladder tumor that is similar in cystoscopic appearance to cystitis glandularis and represents a type of superficial bladder proliferative disorder. The adenoma is often associated with genitourinary (bladder) stones, trauma, exstrophy, malakoplakia, Mullerian lesions, chronic or recurrent bladder infections, interstitial cystitis, renal transplantation, radiation therapy, pelvic lipohypertrophy, intravesical therapy, foreign bodies, or surgery such as bladder augmentation. The adenoma may grow to cause obstructive urinary symptoms and may be multifocal.