WCN26-7929 CYSTITIS CYSTICA ET GLANDULARIS AND RENAL TRANSPLANT- A CASE BASED FEASIBILITY ANALYSIS

Introduction: Urinary bladder abnormalities result in significant mortality and morbidity worldwide. Cystoscopy, a commonly employed method for identifying lower urinary tract abnormalities, has its own limitations. Histopathology has been proved to be gold standard for effective typing, staging, and assessing the microscopic infiltration in malignant cases. The present study was thus undertaken to examine urinary bladder biopsy samples obtained after cystoscopy and to compare the cystoscopic findings with those of histopathology. Materials and Methods: It was a prospective observational, study including hundred urinary bladder biopsies conducted with cystoscopic guidance at a tertiary care hospital over a one-year period. Results: Out of the total one hundred biopsies, 24 showed non-neoplastic conditions, while 76 were neoplastic on histopathological examination. Among the non-cancerous lesions there were 4 cases of follicular cystitis, 4 of tuberculous cystitis, 1 of eosinophilic cystitis, 4 of cystitis cystica, 7 of squamous metaplasia, two each of nephrogenic metaplasia amyloidosis. The neoplastic category (76/100) included papilloma, papillary neoplasm of low malignant potential (PUNLMP), urothelial carcinomas adenocarcinomas, squamous cell carcinomas and, small cell carcinoma. Muscle invasion was observed in 12 cases, and vascular invasion in 7 cases. The final diagnosis was achieved using histopathology. Conclusion: Cystoscopic and histopathological analysis complement each other in evaluating bladder abnormalities, however histology remains the gold standard in arriving at the final diagnosis.

AimsCystitis glandularis (CG) and cystitis cystica et glandularis (CCEG) are benign proliferative lesions of the bladder that may closely mimic carcinoma on imaging, cystoscopy, and histology. Their natural history and malignant potential remain uncertain, which can make management challenging for urologists. This study aimed to analyze the clinical behavior and malignant potential of CG and CCEG by reviewing a decade of institutional experience alongside current literature.MethodsThis retrospective observational review of all patients diagnosed with CG, cystitis cystica, or CCEG at Guy's and St Thomas' Hospital was conducted over a 10-year period. Demographic data (including age, sex, ethnicity, and relevant clinical history), presenting symptoms, imaging and cystoscopic findings, histopathology, treatment, and follow-up information were collected. The published literature was reviewed with a focus on histological features, immunohistochemistry, molecular findings, and the possible association with malignancy.ResultsSixty-seven patients were identified. Median age at diagnosis was 61 years (range: 39-84 years), and 57 (85.1%) were male. The most common presentations were lower urinary tract symptoms (LUTS; 28.4%), visible hematuria (20.9%), and non-visible hematuria (16.4%). Cystitis glandularis was present in 30 (44.8%) patients, and intestinal-type metaplasia in 16 (23.9%) patients. Cystitis cystica was found in 53 cases (79.1%), and was associated with urothelial carcinoma in six (9.0%) patients. Lesions most frequently involved the bladder neck or trigone (62.7%). Median follow-up was 9.2 years (range: 2.2-17.8 years). No patient in this series developed de novo carcinoma arising from CG or CCEG during surveillance. Two patients with extensive trigonal involvement and upper tract obstruction underwent robot-assisted bilateral ureteric reimplantation.ConclusionCG and CCEG are usually benign conditions but can be difficult to distinguish from primary adenocarcinoma of the bladder, especially when intestinal-type metaplasia or mucus extravasation is present. The intestinal variant, particularly when extensive or associated with dysplasia, has been proposed as a potential premalignant lesion. Molecular studies show some overlap in gene expression profiles between CG and urothelial carcinoma, but clinical series have not consistently demonstrated an increased risk of progression. Management is centered on relief of underlying irritation, endoscopic resection of mass-like lesions, and surveillance in selected cases. In patients with extensive disease causing obstruction, reconstructive procedures, such as ureteric reimplantation or, rarely, cystectomy, may be required.

Demystifying Cystitis Cystica—Case Series With Comprehensive Review of Literature

Introduction: Cystitis glandularis and cystitis cystica are benign proliferative conditions of the bladder mucosa, often arising as a reactive response to chronic irritation or inflammation. While frequently asymptomatic, they can occasionally present with alarming symptoms such as gross hematuria and urinary retention, mimicking malignancy. Case Presentation: We report the case of a 43-year-old uncircumcised male who presented with acute urinary retention and gross hematuria due to intravesical blood clots. Physical examination revealed suprapubic fullness and a mildly enlarged prostate. A three-way Foley catheter with manual irrigation was required for decompression. Cystoscopic examination showed multiple raised mucosal lesions and pseudopolyps with active bleeding in the posterior bladder wall. Histopathological analysis of the bladder biopsy confirmed the diagnosis of cystitis glandularis and cystitis cystica. The patient was managed conservatively with non-steroidal anti-inflammatory drugs (NSAIDs), bladder irrigation, and increased hydration. Conclusion: Although benign, cystitis glandularis and cystitis cystica can present with severe urological symptoms such as hematuria with clot retention. Prompt evaluation with cystoscopy and biopsy is essential to exclude malignancy. Conservative management is often effective, but ongoing surveillance is recommended due to the potential for recurrence and the rare risk of malignant transformation.

A 16-year-old girl with a history of partial liver transplant at the age of 5 due to autoimmune hepatitis undergoes a routine follow-up abdominal ultrasound that reveals bladder wall thickening and pseudopolypoid lesions. Cystoscopy and biopsy initially confirm polypoid cystitis cystica and later a nephrogenic adenoma, a rare benign tumour with malignant potential. Pre-operative abdominal MRI unexpectedly detects a foreign body in the vagina, later removed and identified as a 5x3 cm plastic cap. This case highlights the importance of thorough and open-minded clinical evaluation, even in asymptomatic patients, and raises awareness of the long-term complications associated with retained foreign bodies.

Cystitis cystica and glandularis is a rare pathological condition characterised by cystic and glandular proliferations of the bladder wall. This case report presents a unique instance of bladder outlet obstruction (BOO) caused by this condition at the bladder neck, emphasising clinical manifestations, surgical intervention and postoperative outcomes. A literature review further contextualises this diagnosis within urology.

We report a series of six cases of cystitis cystica confirmed on histopathology, who presented to the urology centre of the tertiary care hospital between September 2023 and July 2024. Clinical examination revealed bilateral digital clubbing of both upper and lower limbs in all cases (Range grade 3 to grade 4). All patients belonged to the male gender aged between 24 years and 43 years. None of them gave a family history of clubbing. Two patients gave a history of having spent time in the high-altitude area (more than 2400 m above sea level) at the time of presentation. None of them displayed cyanosis or any other clinical features of chronic heart or lung diseases. All of them had normal chest X-rays, electrocardiogram, and ultrasonography of the abdomen. The acute phase reactants, biochemical and haematological parameters were within normal limits in all cases. Vascular endothelial growth factor and platelet-derived growth factor may be postulated as the common denominator in the association between clubbing and inflammatory changes in cystitis cystica. The association of cystitis cystica and digital clubbing has not been reported to date. This serendipitous correlation warrants further observation to authenticate the association.

A well-differentiated neuroendocrine tumour of the urinary bladder associated with cystitis cystica

We report a 49-year-old man who had a progressive rash that covered 90% of his total surface area in a period of 5 years. Confluent scaly erythematous plaques, which started on the upper back and spread to involve the scalp, face, chest, and limbs. Notable observations were subungual hyperkeratosis and onychogryphosis in all nails, along with follicular keratotic papules with waxy keratoderma on the palms and soles. Biopsy from skin lesions were suggestive of PRP. A focal hypoechoic thickening at the base of the bladder was found during abdominal ultrasonography, which could indicate edema or a tumor. Histopathological examination of the removed tissue following TURBT revealed cystic urothelial nests that were consistent with Cystitis Cystica Glandularis (CCG), ruling out cancer. This case underscores the importance of a thorough investigation in patients with extensive dermatoses, highlighting a rare association between PRP and cystic bladder lesions

Quantitative proteomics and immunohistochemistry uncover NT5DC2 as a diagnostic biomarker for papillary urothelial carcinoma

PD20-03 DIAGNOSTIC PERFORMANCE OF PHOTODYNAMIC DIAGNOSIS WITH ORAL 5-AMINOLEVULINIC ACID FOR BLADDER AND UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE-CENTER, RETROSPECTIVE ANALYSIS

Based on lineage-specific transcription factors, small-cell neuroendocrine carcinoma (SmCC) of the urinary bladder has recently been subtyped into three molecular subtypes: ASCL1, NEUROD1 and POU2F3. The latter is a master transcriptional regulator of tuft cells (TCs) which are rare solitary cells found in various mucosal epithelia such as the gastrointestinal tract, but which have not been reported in the bladder. The POU2F3 subtype shows low or absent neuroendocrine marker expression. A case of mixed SmCC and conventional-type urothelial carcinoma (CUC) of the urinary bladder with POU2F3-expressing intraepithelial small-cell carcinoma in keeping with a tuft cell phenotype, arising in association with intestinal metaplasia (IM) is described. The presence of POU2F3-expressing cells in normal urothelium, cystitis cystica glandularis and IM of the urinary bladder is demonstrated in separate cases of cystitis cystica glandularis with IM. Also, POU2F3 expression is identified in a subset of bladder SmCC.

Fibroepithelial polyps (FEPs) of the urinary tract are a rare benign tumour in the bladder. It arises from mesoderm and is mostly found in the ureter and ureteropelvic region. The authors report a case of a six-year-old girl with no history of urogenital abnormality who presented with haematuria and suprapubic pain. Ultrasound and computed tomography showed a large multilobulated mass in the urinary bladder. The resected specimen exhibited a bulbous mass with a botryoid surface. Microscopically, the polypoidal lesion is covered by reactive transitional epithelium with the presence of cystitis cystica et glandularis with scattered spindle cells; fibroblast and smooth muscle cells. By excluding all the differential diagnoses according to histomorphology and immunostain findings, diagnosis of Giant Botyroid FEP is made. This paper also discussed the differential diagnosis for FEP.

Background: Cystitis cystica and glandularisare benign bladder lesions resulting of transformation of urothelium.It is diagnosed frequently incidentally or may manifest with non-specific urinary tract symptoms. Although regarded as innocuous it may lead to upper urinary tract obstruction. We report two cases ofcystitis cystica and glandularis in adultmale patients complicated with renal impartment. The firstpatient underwent respectively percutaneous nephrostomies, internal stents and bilateral ureteral reimplantation. In the second we performed bilateral internal stents that are regularly changed. Theses cases demonstrate the challenge to manage severe complications of a benign pathology. Given the potential complicationsand recurrence of this pathology, a regular follow up is a necessary.

A diverse spectrum of pathologically distinct, nonneoplastic, proliferative conditions of the kidneys and urinary tract demonstrate a expansile growth pattern similar to that of neoplasms. The renal pseudotumors include myriad causes of infections as well as rare noninfectious causes such as sarcoidosis, amyloidosis, and immunoglobulin G4-related disease (IgG4-RD). Rare entities such as cystitis cystica, endometriosis, nephrogenic adenoma, and pseudosarcomatous myofibroblastic proliferation and distinct types of prostatitis comprise tumefactive nontumorous disorders that affect specific segments of the urinary tract. The pseudotumors of the kidneys and urinary tract demonstrate characteristic histopathologic and epidemiologic features, as well as protean clinical manifestations, natural history, and imaging findings. Many patients present with genitourinary tract-specific symptoms or systemic disease. Some cases may be incidentally discovered at imaging. Some entities such as perinephric myxoid pseudotumors, IgG4-RD, fibroepithelial polyp, and nephrogenic adenoma display specific anatomic localization and disease distribution. Imaging features of multisystem disorders such as tuberculosis, sarcoidosis, and IgG4-RD provide supportive evidence that may allow precise diagnosis. Fungal pyelonephritis, xanthogranulomatous pyelonephritis, IgG4-RD, actinomycosis, and endometriosis show markedly low signal intensity on T2-weighted MR images. Although some pseudotumors exhibit characteristic imaging findings that permit correct diagnosis, laboratory correlation and histopathologic confirmation are required for definitive characterization in most cases. A high index of suspicion is a prerequisite for diagnosis. Accurate diagnosis is critical for instituting optimal management while preventing use of inappropriate therapies or interventions. Surveillance CT and MRI are frequently used for monitoring the response of pseudotumors to therapy. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

The present investigation describes the spontaneous pathological lesions in urinary bladders (n = 177) of slaughtered buffaloes collected from Northern India. Gross examination revealed congestion, haemorrhages, oedematous changes and thickening of mucosa. Microscopically, epithelial abnormalities, inflammatory and neoplastic conditions were noticed. Epithelial abnormalities included epithelial hyperplasia, von Brunn’s nests, cystitis cystica and cystitis glandularis. Inflammatory conditions such as congestion, haemorrhages and cystitis were noticed. Cystitis was classified as lymphocytic, plasmo-lymphocytic, follicular and interstitial types. However, only single case of haemangiosarcoma was observed. Polymerase chain reaction revealed the presence of DNA of only BPV-1 in one sample out of 21, while one sample showed the presence of DNA of both BPV-1 and BPV-2. On immunohistochemistry, Ki-67 expression was observed only in haemangiosarcoma and one case of plasmo-lymphocytic cystitis with immunostaining restricted to nuclei. COX-2 immunostaining was observed in one case each of flat hyperplasia, von Brunn’s nest, haemangiosarcoma and two cases of plasmo-lymphocytic cystitis. Among epithelial abnormalities, COX-2 immunostaining was restricted to epithelial component of the lesions, and it was diffused cytoplasmic type with occasional perinuclear staining particularly in the cytoplasmic membrane. However, in haemangiosarcoma the COX-2 immunoreactivity was noticed in epithelial as well as connective tissue stroma. In conclusion, it may be stated that urinary bladders of slaughtered buffaloes showed a number of epithelial abnormalities, inflammatory conditions and occasionally neoplasms. Further studies to explore the infectious as well as non-infectious etiologies should be undertaken.

V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS

Cystitis cystica et glandularis (CCEG) and intestinal metaplasia are benign diseases indistinguishable from a bladder tumor on cystoscopy. Despite the benign nature, these pathological changes can be underlying in adenocarcinoma of the bladder. One more unsolved problem is the recurrent glandular cystitis. The article considers the modern classification of benign bladder diseases and clinical examples of recurrent cases of glandular cystitis.

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