Eosinophilic Cystitis Research Articles

MR imaging findings of eosinophilic cystitis in an 8-year-old girl

Eosinophilic cystitis is a rare inflammatory condition of the urinary bladder of unknown aetiology and characterized by eosinophilic infiltration of the bladder wall. We report the unique MR findings of eosinophilic cystitis in an 8-year-old girl who presented with peripheral eosinophilia. MR imaging revealed smooth and nearly circumferential thickening of the bladder wall showing distinct low signal intensity on T2-weighted images, which may histologically represent high cellularity due to massive eosinophilic infiltration.

Eosinophile Zystitis als Symptom eines idiopathischen hypereosinophilen Syndroms

Eosinophilic cystitis as a symptom of an idiopathic hypereosinophilic syndrome is a very rare clinical picture with an unpredictable course. A combination of both symptoms has not been described previously in the peer reviewed literature. As a result of this myeloproliferative disease there is a pathologically increased production of eosinophils in the blood which, in turn, can cause organ complications. Cardiovascular, thromboembolic and pulmonary disease have been reported as complications in the oncological literature. A girl aged 2 years and 4 months developed a massive intraluminal tumour of the bladder as a result of eosinophilic cystitis. Because of the rareness of this disease standardized therapy regimens do not exist; however, individualized treatment and close. Oncological follow-ups are highly recommended. The Aim should be to reduce the excessive production of eosinophil in order to avoid organ manifestations. Even so, the course of the disease remains unpredictable.

Eosinophilic cystitis simulating invasive bladder cancer: a real diagnostic challenge

To report our experience with eosinophilic cystitis (EC) presented as invasive bladder cancer. We recently treated three patients with bladder masses mimicking neoplasms and biopsy proved the diagnosis of EC. Data from our three patients were presented. There were two females and one male with ages of 14, 43 and 38 years. All the three patients had irritative bladder symptoms, suprapubic pain and hematuria. Bladder mass was detected by pelvic examination in the three patients and confirmed by radiologic tests and cystoscopy. In one patient, the mass caused bilateral hydroureteronephrosis while the upper tract was normal in the other two. Elevated serum leukocytes was evident in the three cases while peripheral eosinophilia was observed in one. Biopsy showed EC in all the three patients who were treated by transurethral resection of the lesions followed by a combination of corticosteroids, antibiotics and antihistaminics. All patients experienced marked improvement during a follow-up duration up to 30 months. EC is a rare disease. In addition to symptoms of frequency, dysuria, hematuria and suprapubic pain, the disease may present with a bladder mass mimicking invasive bladder cancer. Resection of the lesion is mandatory with systemic treatment of corticosteroids, antihistaminics and antibiotics. Early detection and prompt treatment usually result in a good prognosis.

Inflammatory and Nonneoplastic Bladder Masses: Radiologic-Pathologic Correlation

Although the vast majority of bladder tumors are epithelial neoplasms, a variety of nonneoplastic disorders can cause either focal bladder masses or diffuse mural thickening and mimic malignancy. Some of these entities are rare and poorly understood such as inflammatory pseudotumor, which produces ulcerated, bleeding polypoid bladder masses. These masses may be large and have an extravesical component. Bladder endometriosis manifests as submucosal masses with characteristic magnetic resonance imaging features consisting of hemorrhagic foci and reactive fibrosis. Nephrogenic adenoma has no typical features, and pathologic evaluation is required for diagnosis. Although imaging features of malacoplakia are also nonspecific, characteristic Michaelis-Gutmann bodies are found at pathologic evaluation. The various types of cystitis (cystitis cystica, cystitis glandularis, and eosinophilic cystitis) require pathologic diagnosis. Bladder infection with tuberculosis and schistosomiasis produces nonspecific bladder wall thickening and ulceration in the acute phase and should be suspected in patients who are immunocompromised or from countries where these infections are common. The diagnosis of chemotherapy cystitis and radiation cystitis should be clinically evident, but imaging may be used to determine severity and to assess complications. Extrinsic inflammatory diseases such as Crohn disease and diverticulitis may be associated with fistulas to the bladder and focal bladder wall abnormality. The extravesical findings allow the diagnosis to be made easily. Finally, extrinsic masses arising from the prostate or distal ureter may cause filling defects, which can be confused with intrinsic bladder masses.

Eosinophilic cystitis in children

目的 分析儿童嗜酸性膀胱炎的临床及CT表现.方法 对9例经病理证实的儿童嗜酸性膀胱炎(7例)及嗜酸性肉芽肿性膀胱炎(2例)的临床及CT表现进行研究.结果 临床上均伴有血尿、膀胱刺激征、排尿困难和腹痛等症状.影像学上,4例表现为膀胱壁结节状或局限性增厚,其中2例为嗜酸性肉芽肿性膀胱炎,其余5例表现为膀胱壁弥漫性不均匀增厚.结论 嗜酸性膀胱炎的影像学及临床表现与膀胱肿瘤易于混淆,病变的活检定性对于作出正确诊断及制定相应治疗方案是必不可少的步骤。

Severe eosinophilic cystitis in a woman with anorexia nervosa

Eosinophilic cystitis is a rare inflammatory disorder. It is considered to be self limiting necessitating only supportive therapy. Surgical intervention is unusual. We report here an association between eosinophilic cystitis and anorexia nervosa in an adult woman requiring radical surgery for progressive relentless disease. Estrogen deficiency associated with a possible allergic etiology could explain this association.

Eosinophilic cystitis causing spontaneous rupture of the urinary bladder in a child

We report a unique case of eosinophilic cystitis causing intraperitoneal bladder perforation in a child diagnosed by chance with no signs or history of trauma. To our knowledge, this is the first case of eosinophilic cystitis complicated by bladder rupture in children. The patient was successfully treated with primary repair. For children with non-traumatic bladder perforation, eosinophilic cystitis must be considered in the differential diagnosis.

Eosinophilic cystitis: Successful long-term treatment with montelukast sodium

We report a rare case of eosinophilic cystitis in a 6-year-old boy who presented with irritative voiding symptoms, peripheral eosinophilia, and a bladder mass initially visualized on ultrasonography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Complete resolution of his symptoms occurred within 1 week of corticosteroid use and the x-ray findings improved within 6 weeks. At 6 months of follow-up, the patient continued to require a leukotriene receptor antagonist (montelukast sodium) despite several attempts to discontinue its use. We propose that eosinophilic cystitis in children who present with peripheral eosinophilia will often require long-term treatment.

CLINICAL MANIFESTATIONS AND FUNCTIONAL OUTCOMES IN CHILDREN WITH EOSINOPHILIC CYSTITIS

Eosinophilic cystitis is a rare disorder, with fewer than 30 pediatric cases reported in the literature. We describe our experience with pediatric eosinophilic cystitis during a 20-year period. Four children referred to our institution were subsequently diagnosed with eosinophilic cystitis between 1984 and 2004. A retrospective chart review was performed to assess clinical presentation, diagnosis, treatment and outcomes. Mean patient age at presentation was 10.8 years (range 5 to 18) and male-to-female ratio was 3:1. All 4 patients presented with irritative urinary symptoms, including 3 with dysuria and/or gross hematuria and 2 with urinary frequency, lower abdominal pain and/or a concomitant urinary tract infection. Allergic diseases (asthma, allergic rhinitis, etc) were present in 3 patients, and a formal allergen skin test was positive in 2 of those tested. A bladder mass mimicking malignancy was documented in 2 patients. Three patients had symptom resolution with conservative treatment, while 1 had development of an unremitting tumefactive process that eventually required partial cystectomy and bladder augmentation. Eosinophilic cystitis is a rare condition with a wide range of clinical manifestations. Children can present with a bladder mass mimicking sarcoma, underscoring the need for biopsy before diagnosis and treatment of a presumed oncological process. The condition usually follows a benign course, although unremitting progression remains a possibility.

THE ACTUAL INCIDENCE OF BLADDER PERFORATION FOLLOWING TRANSURETHRAL BLADDER SURGERY

In this prospective study we evaluated the incidence of bladder perforation after transurethral bladder tumor resection. A total of 36 patients (33 male, 3 female, mean age +/- SD 65.6 +/- 11.43 [range 26 to 81]) with a solid mass in the bladder (mean 20.3 +/- 8.7 mm, range 5 to 40) were included in the study. Transurethral resections were performed with a 24Fr resectoscope. After the procedure an 18Fr Foley catheter was inserted into the bladder and 400 ml of 1/4 saline diluted contrast solution was instilled under gravity from 60 cm above the bladder. Complete filling and post-drainage radiographs were taken and examined for any evidence of extravasation. Regular evaluations with cystoscopy and ultrasound/computerized tomography were done to detect possible tumor recurrence and perivesical seeding. Histopathological examination of the tumors showed transitional cell carcinoma in 35 patients and chronic eosinophilic cystitis in 1. Review of the cystograms revealed various degrees of extraperitoneal contrast extravasation around the resected area in 21 patients (58.3%). The only statistically significant difference between patients with and without extravasation was in tumor size (logistic stepwise regression p = 0.030,) among factors tested including patient age and localization, number of foci, tumor grade and stage. No apparent clinical problems requiring medical or surgical intervention other than urethral catheterization developed and no evidence of extravesical tumor seeding as per ultrasound and/or computerized tomography was seen during a mean followup of 21.9 months (range 7 to 40). The extravasation of urine (asymptomatic perforation) after transurethral bladder tumor resection may occur much more frequently than believed or reported. It seems that this extravasation does not impose a significant risk of extravesical tumor seeding.

Hypereosinophilic syndrome presenting with eosinophilic colitis, enteritis and cystitis

Hypereosinophilic syndrome presenting with eosinophilic colitis, enteritis and cystitis

EOSINOPHILIC CYSTITIS IN A NEONATE

A 4-week-old black full-term female underwent evaluation of an incidental bladder mass discovered during evaluation for microscopic hematuria and oliguria. The patient had a milk protein allergy leading to severe dehydration and cerebral thrombosis. Prenatal and urological history was unremarkable. Urine cultures were negative and peripheral eosinophilia was not present. Renal and bladder ultrasound, voiding cystourethrogram and magnetic resonance imaging all demonstrated a bladder mass along the posterior wall of the bladder, and normal kidneys (figs. 1 and 2). Cystoscopy confirmed a solid midline trigonal mass. Transurethral excisional biopsy was performed, and pathological examination revealed the presence of fibroconnective tissue withch ronic inflammatory infiltrate composed of lymphocytes and eosinophils, consistent with the diagnosis of eosinophilic cystitis. Due to the self-limited nature of this asymptomatic problem and lack of malignant degeneration, we chose to observe the patient. Followup bladder ultrasound at 6 weeks and 3 months showed a small residual bladder mass. DISCUSSION

Eosinophilic cystitis and its management

Eosinophilic cystitis (EC) is a rare clinicopathological condition characterized by transmural inflammation of the bladder predominantly with eosinophils, associated with fibrosis with or without muscle necrosis. The cause of EC remains unclear, although it has been associated with various aetiological factors, such as allergy, bladder tumour, bladder trauma, parasitic infections and chemotherapeutic agents. EC is, probably, caused by the antigen-antibody reaction. This leads to the production of various immunoglobulins, which, in turn, cause the activation of eosinophils and initiates the inflammatory process. The most common symptom complex consists of frequency, haematuria, dysuria and suprapubic pain. Cystoscopy and biopsy are the gold standard for diagnosis. Additional laboratory evidence supporting the diagnosis includes proteinuria, microscopic haematuria and peripheral eosinophilia, the last one occurring in few patients. There is no curative treatment for this condition. Current treatment modalities include transurethral resection of the bladder lesion along with non-specific medical therapy, such as non-steroidal anti-inflammatory agents or steroids. Because the lesion tends to recur in spite of the above therapy, long-term follow-up is mandatory.

X-Linked Chronic Granulomatous Disease: First Report of Mutations in Patients of Argentina.

Chronic granulomatous disease (CGD) is a primary immunodeficiency due to absent or decreased NADPH oxidase activity in phagocytic cells. The X-linked form of the disease (X-CGD) arises from mutations in the CYBB gene, which encodes the 91-kD glycoprotein gp91, the largest component of the oxidase. The authors recently started the molecular characterization of X-CGD in 18 patients reported to the Argentinean Registry of Primary Immunodeficiency Diseases. The authors reviewed data from clinical records to examine the relationship of clinical presentation and the type of mutations responsible for the genotype. The frequency and type of infections present in these patients were similar to prior reports. However, pulmonary tuberculosis was observed in the group as well as unusual complications such as eosinophilic cystitis, hepatic abscess with cholangitis, and chronic orchitis. Eleven different mutations in the CYBB gene were identified, and seven of them were novel. The types of mutations were intronic, single-nucleotide substitution resulting in nonsense or missense codons and one or two nucleotide deletions resulting in frameshifts. Molecular studies of 18 mothers revealed X-CGD carrier status in all but 2. No correlation existed between the type of mutation and the clinical phenotype of the disease: the molecular defects identified resulted in no expression of the flavocytochrome b558 in patients' neutrophils, leading to the X91°-CGD phenotype. The lack of gp91 protein could explain the early onset and the severity of the clinical manifestations of CGD in this group of patients from Argentina.

Plasma cell infiltration of the urinary bladder

We report a novel entity of plasma cell bladder infiltration without other demonstrable disease. The patient had severe irritative voiding symptoms, hematuria, and a diffuse mucosal infiltrate with 90% plasma cells. Although the patient demonstrated some clinical and pathologic evidence consistent with interstitial cystitis and eosinophilic cystitis, a predominant finding of focal plasma cell infiltration of the urinary bladder suggests a new or previously unrecognized clinical entity.

Eosinophilic cystitis after bladder instillation with dimethyl sulfoxide

Eosinophilic cystitis is a rare and poorly understood disorder. We report the first case of an acute flare of eosinophilic cystitis in a 51-year-old woman after bladder instillation with dimethyl sulfoxide (DMSO) for presumed interstitial cystitis. The patient presented with severe bladder pain, fever, and eosinophilia several hours after instillation. These symptoms were unresponsive to conventional analgesic and antibiotic treatments. Cystoscopy revealed erythema and exudate at the bladder walls, along with edema of both ureteral orifices. Bladder biopsies demonstrated massive eosinophilic infiltration of the bladder, confirming the diagnosis of eosinophilic cystitis. Urologists should bear in mind this clinical entity, particularly when DMSO is administered to patients with multiple drug allergies.

EOSINOPHILIC CYSTITIS IN A CHILD PRESENTING WITH A BLADDER MASS

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Apr 2004EOSINOPHILIC CYSTITIS IN A CHILD PRESENTING WITH A BLADDER MASS JOHN C. THOMAS and JONATHAN H. ROSS JOHN C. THOMASJOHN C. THOMAS More articles by this author and JONATHAN H. ROSSJONATHAN H. ROSS More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000115722.65503.d9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "EOSINOPHILIC CYSTITIS IN A CHILD PRESENTING WITH A BLADDER MASS." The Journal of Urology, 171(4), pp. 1654–1655 References 1 : Tumor-forming eosinophilic cystitis in children. Case report and review of literature. Eur Urol1994; 25: 138. Google Scholar 2 : Eosinophilic granulomatous cystitis in children. Urology1995; 46: 732. Google Scholar 3 : Diagnosis and management of eosinophilic cystitis: a pooled analysis of 135 cases. Eur Urol2000; 37: 386. Google Scholar From the Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byTHOMPSON R, DICKS D and KRAMER S (2018) CLINICAL MANIFESTATIONS AND FUNCTIONAL OUTCOMES IN CHILDREN WITH EOSINOPHILIC CYSTITISJournal of Urology, VOL. 174, NO. 6, (2347-2349), Online publication date: 1-Dec-2005. Volume 171Issue 4April 2004Page: 1654-1655 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordscystitiseosinophiliabladder neoplasmsMetricsAuthor Information JOHN C. THOMAS More articles by this author JONATHAN H. ROSS More articles by this author Expand All Advertisement PDF downloadLoading ...

Eosinophilic Cystitis

Purpose: We present a large series of eosinophilic cystitis including 8 cases; 3 of them had tumor-like lesions. Materials and Methods: The archives of pathology clinic of Inonu University Medical Faculty were reviewed from 1988 to 2002. The characteristics of patients and their diseases were recorded. Data obtained from 180 cases (172 from the literature and 8 from the present series) was assessed. Results: Seven cases had symptoms such as dysuria, frequency, hematuria, suprapubic pain, and difficulty in voiding. One asymptomatic case with history of bladder carcinoma was diagnosed during routine cystoscopy. The findings were microhematuria in 6 cases, macrohematuria in 2, pyuria in 3, urinary infection in 1, eosinophilia in 1, hyperazotemia in 1, and bladder masses in 3. Cystoscopies detected edematous and erythematous areas in 5 cases and lesions mimicking bladder carcinoma in 3. One case did not take further treatment after cystoscopy and biopsy and completely recovered. Four cases underwent medical therapy with nonsteroidal anti-inflammatory drugs and antihistaminics. They became asymptomatic and control cystoscopies showed no abnormal finding. Two of three patients with mass lesions recovered after steroid therapy following transurethral resection. The lesion in the third recurred and he improved after a second course of steroid therapy. Conclusions: Eosinophilic cystitis is a rare pathology. Sometimes, it may simulate bladder malignancies. Biopsy is mandatory at diagnosis. Usually, it has a benign course and may be treated with fulguration, analgesics, antihistaminics and steroids, although recurrence is possible.

Fibrose vésicale due à une cystite à éosinophiles

A 70-years-old man with no history of allergy or genitourinary problems had bilateral hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic infiltration with fibrosis of the bladder wall. A total cystoprostatectomy with ileal bladder replacement was performed. We reviewed the literature of eosinophilic cystitis for clinical presentation, diagnosis and therapeutic options.

Extensive Inflammatory Eosinophilic Bladder Tumors in Children: Experience With Three Cases

Eosinophilic cystitis, an uncommon lesion, is rare in children; < 25 cases have been reported. The intense inflammatory changes in the bladder wall associated with this lesion may produce heaped-up excrescences, which resemble vesical rhabdomyosarcoma. Our experience with 3 patients shows that the initial diagnosis of eosinophilic cystitis may not be easily made, and that the lesions produced may mask other disease processes. We alsoreport the fifth case of eosinophilic infiltration of the bladder occurring in association with chronic granulomatous disease.