Cystitis glandularis.

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CYSTITIS GLANDULARIS is characterized by the proliferation of mucus-secreting glands in the mucosa and submucosa of the bladder (7, 8). Although the cystoscopic and pathologic characteristics of the disease have been extensively described (2, 3, 6–8, 10, 12, 14), the roentgen appearance of the disease has been but sketchily portrayed (6, 11, 13, 14). We have been unable to find reference to this condition in the English language radiological literature. Two distinct forms of cystitis glandularis are recognized cystoscopically and pathologically (2, 3, 6, 8, 10, 12). The first has an irregular villous appearance cystoscopically and is usually located in the dome of the bladder. The second type is found ordinarily near the vesical neck and trigone, frequently adjacent the ureteral orifices. The cystoscopic appearance in this form is one of multiple mammillated elevations with a sharp demarcation between the abnormal and normal mucosa (10, 12). Microscopically, the lesions consist of either a single layer of mucus-producing goblet cells resembling the mucosa of the large bowel or multilayered mucus-producing cells that resemble normal prostatic glands. Each of these cell types has been found in both the bladder dome and trigone area (12). Frequently, cystitis glandularis is associated with cystitis cystica, a condition characterized by the presence of epithelial-lined cysts in the mucosa and submucosa of the bladder (5, 8). Most authors feel that both conditions are caused by inflammation of the bladder and that under this stimulus embryonal cell nests proliferate to form either cystitis cystica or cystitis glandularis (1, 7, 8, 10, 12). It is notable, however, that whereas almost all cases of cystitis cystica are associated with chronic inflammation (5), only about one-half of the cases of cystitis glandularis have a history of chronic inflammation of the bladder (2, 3,12). Since the lesions of cystitis glandularis may be sessile or pedunculated, they may simulate the cystoscopic appearance of carcinoma of the bladder. The histologic appearance may be confused with carcinoma on occasion (2, 6). The disease usually runs a benign course (2, 6, 7, 12,15), however, although at least one well documented case of malignant transformation of cystitis glandularis to adenocarcinoma of the bladder is recorded (13). The possibility has been raised that cystitis glandularis is a precancerous lesion and may be the forerunner of the rare adenocarcinoma of the bladder (1, 4, 8, 10, 13,15). Roentgen Appearance Since cystitis glandularis is primarily diagnosed by cystoscopy and biopsy, little mention has been made of its roentgenologic manifestations. Instances of uretero-pyelocaliectasis and ureteropyelocystitis demonstrated by excretory urography have been described (11, 14). Two cases showing large filling defects in the bladder are recorded (6,13).