Abstract
Cystitis glandularis (CG) is an unusual proliferative disorder of the urinary bladder, which is characterized by transitional cells that have undergone glandular metaplasia. Cystitis glandularis has occasionally been proposed as a precursor of adenocarcinoma by various studies. Also, the intestinal subtype of cystitis glandularis has been described as premalignant. Here, we report a case of 37 year old female presenting with hematuria and acute retention of urine with cystoscopy revealing a pedunculated growth arising from the anterior wall of the bladder. Transurethral resection of the bladder tumour was performed and histopathology suggested cystitis glandularis with intestinal metaplasia. Immunohistochemical study was done using CDX2 and CK20 which showed nuclear and cytoplasmic positivity respectively and hence the diagnosis was confirmed. Intestinal metaplasia is a risk factor and a putative precursor of adenocarcinoma. Hence the, proper evaluation of the histological features and immunohistochemical studies of cystitis glandularis, especially intestinal type helps in correct categorization of this lesion.
 Due to the increased occurrence of adenocarcinoma in patients with cystitis glandularis, it is recommended to have a close follow up of the patients diagnosed with cystitis glandularis with intestinal metaplasia because it may turn malignant.
Highlights
A wide spectrum of glandular epithelial metaplastic changes may be seen in the bladder.In 1761, Morgagni first described cystitis glandularis as a benign proliferative disorder of the bladder for which the pathogenesis was thought to be either congenital due to partial origin of the bladder from embryonal cloaca or due to longstanding irritation causing metaplasia of the urothelium [1]. 3
Formalin-fixed, paraffin-embedded tissue samples were subjected to immunohistochemical analysis with CDX2 and Immunohistochemical study done using CDX2 and CK20 showed nuclear and cytoplasmic positivity respectively and the diagnosis was confirmed (Figs. 6,7)
The second type i.e. the intestinal type, referred to as cystitis glandularis with intestinal metaplasia is characterised by glands lined with mucinous columnar epithelium with basally located nuclei and frequent goblet cells [2]
Summary
A wide spectrum of glandular epithelial metaplastic changes may be seen in the bladder. In 1761, Morgagni first described cystitis glandularis as a benign proliferative disorder of the bladder for which the pathogenesis was thought to be either congenital due to partial origin of the bladder from embryonal cloaca or due to longstanding irritation causing metaplasia of the urothelium [1]. The specimen was received in 10% buffered neutral formalin. After formalin fixation, macroscopic examination of the specimen was done. Two types of cystitis glandularis have been identified on microscopy - the usual type and intestinal type. Cystitis glandularis of intestinal type is a relatively rare condition and has often been misdiagnosed as bladder tumour [1]. With similar clinical features as other bladder tumours, it has an unclear pathogenesis and its role as a precursor of adenocarcinoma has long been debated. We report a case of Intestinal type of Cystitis Glandularis in a 37 year old female patient
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