Follicular Cystitis Research Articles

Detection of Residual Tumor Cells in Bladder Biopsy Specimens: Pitfalls in the Interpretation of Cytokeratin Stains

Some patients who have had prior bladder biopsies or transurethral resections undergo a repeat resection within several months for various reasons. The detection of a few residual tumor cells in bladder specimens with prior biopsy site changes can be challenging based on histology alone. Immunohistochemistry for cytokeratins may be used as an adjunct in this situation. We have noted several cases in which keratin stains were performed and positive cells were noted, raising the issue as to whether the cytokeratin positive cells were residual tumor cells or stromal cells. Immunohistochemistry for a panel of antibodies [AE1/AE3, CAM 5.2, high molecular weight cytokeratin, smooth muscle actin (SMA), desmin, and anaplastic lymphoma kinase (ALK)] was performed on 29 cases of bladder biopsies with prior biopsy site changes. Of 29 patients, 25 had a prior history of bladder tumor: 17 had invasive high-grade urothelial carcinoma (T1, 5 cases; T2, 11 cases; T3,1 case); 7 had noninvasive high-grade papillary urothelial carcinoma; 1 had noninvasive low-grade papillary urothelial carcinoma). One of the patients with noninvasive high-grade papillary urothelial carcinoma and one of the patents with invasive high-grade urothelial carcinoma had associated carcinoma in-situ. Four patients had prior benign bladder diagnoses: cystitis cystica et glandularis; polypoid cystitis; follicular cystitis; and neurogenic bladder with benign prostate hyperplasia. Of the 29 cases, 6 (21%) had cells with staining for at least 2 of the cytokeratin markers. Cytokeratin (CK) AE1/ AE3 was positive for cells in 8/29 cases (28%). In 6 of these cases, cells displayed a spindle cell and 2 cases a more epithelioid morphology. CAM 5.2 was positive in cells in 5/29 cases (17%); 3 of the cases had spindle cell and 2 cases epithelioid morphology. High molecular weight cytokeratin was expressed in cells in 2/29 cases (7%) with 1 case having spindle cell and 1 epithelioid morphology. SMA was positive in cells with a spindle cell morphology and negative in the more epitheloid cytokeratin positive cells. Desmin was positive in 3/6 keratin positive spindle cells and negative in keratin positive epithelioid cells. ALK was negative in all the cases. Three cases with spindle cell morphology and positivity for at least 1 of the keratins and SMA stains were interpreted as aberrant keratin expression in myofibroblastic cells based on the staining and the morphology of the spindle cells. Another 3 cases with concurrent staining for at least 1 of the keratins, SMA and desmin were consistent with smooth muscle cells on the basis of their cellular morphology. Another 2 cases had cells, which expressed at least 2 CK markers but did not express SMA, desmin, or ALK and a more epithelioid morphology. These cells were interpreted as residual tumors cells. When interpreting CK stains for the detection of residual tumor cells, one should pay attention to the nature of the cells and not assume all CK staining cells are residual tumor cells.

Cistitis folicular: Aportación de un caso y revisión de la literatura

To report one case of chronic follicular cystitis and to perform a bibliographic review on this pathology.We report a case of a 70-year-old woman with an irritative voiding syndrome over an eight-month period, with several previous episodes of urinary tract infection treated by her family doctor. Bullous lesions were found in the bladder mucosa on cystoscopy. Histological tests showed lymphoid follicles at the level of the bladder mucosa, leading to the diagnosis of follicular cystitis.Medical treatment was carried out with ciprofloxacin, vitamin A, and prednisone, which led to symptom remission.Follicular cystitis is an entity that belongs to the group of chronic cystopathies; it is a non-specific chronic inflammatory disease characterized by the presence of large number of plasmatic cells and lymphocytes in lymphoid follicles within the bladder mucosa and submucosa; pathologic study is necessary for the final diagnosis of this entity.

The method of bladder drainage in spinal cord injury patients may influence the histological changes in the mucosa of neuropathic bladder – a hypothesis

BackgroundIn spinal cord injury (SCI) patients, no correlation was found between the number of bladder infections per year, the period since injury, the neurologic level of the spinal cord lesion and the histopathology of the urinary bladder mucosa. The use of chronic indwelling urethral and/or suprapubic catheters in SCI patients is often associated with inflammatory and proliferative pathological conditions in neuropathic bladder.Presentation of the hypothesisWe propose a hypothesis that the type of bladder drainage in SCI patients influences the histological changes in the mucosa of neuropathic bladder. This hypothesis implies that SCI patients with long-term indwelling urinary catheters develop certain histological changes in bladder mucosa, which are seen less frequently in SCI patients, who do not use long-term indwelling catheters. The latter group includes patients, who perform regular intermittent catheterisation and those, who wear a penile sheath and empty their bladders satisfactorily by reflex voiding.We hypothesise that the following histological lesions are seen more frequently in the neuropathic bladder of SCI patients with long-term indwelling catheters.(1) Papillary or polypoid cystitis; (2) widespread cystitis glandularis; (3) moderate to severe, acute and chronic inflammatory changes in bladder mucosa; (4) follicular cystitis; (5) squamous metaplasia; and (6) urothelial dysplasiaAs per this hypothesis, it is postulated that the above pathological conditions are seen less often in SCI patients, who achieve complete, low-pressure emptying of the neuropathic bladder by regular intermittent catheterisation, and SCI patients with penile sheath drainage, who empty their bladders satisfactorily by reflex voiding.Testing the hypothesisA large prospective study of bladder biopsies in SCI patients practising different methods of bladder drainage is required to validate this hypothesis that the histological changes in bladder mucosa are related to the method of bladder drainage in SCI patients.Implications of the hypothesisWe propose a hypothesis that the method of bladder drainage in SCI patients influences histological changes in the bladder mucosa. If this hypothesis is validated, methods of bladder drainage such as intermittent catheterisation, which do not require the use of chronic indwelling catheters, should be recommended, in order to minimise adverse histological changes in the mucosa of neuropathic bladder of spinal cord injury patients.

Follicular Cystitis in Girls with Untreated Asymptomatic or Covert Bacteriuria

Nodular changes of the bladder mucosa, that is cystitis follicularis or cystitis cystica, are found in 2 to 9% of all children with urinary tract infections. The nodules are composed of lymphoid aggregates, resembling Peyer’s patches in the intestine. Children with this finding are considered to have a poor short-term prognosis with a marked tendency for recurrent infections.Screening programs for bacteriuria have revealed that a few per cent of the female population are bacteriuric without symptoms of overt disease. Of 59 girls followed with untreated asymptomatic bacteriuria 52 had nodular changes of the bladder mucosa at cystoscopy. Biopsy was performed in 22 girls, and revealed lymphocytic infiltration in 19 and follicular formation in 11. The nodular changes persisted when bacteriuria continued but disappeared in patients who became abacteriuric. This finding demonstrates the reversibility of the changes, and supports the assumption that they are secondary to the presence of bacteria and not a primary lesion. (J. Urol., 143: 330–332, 1990).

膀胱 pseudolymphoma の1例

We report a 63 year-old female with solid, nonpapillary, and smooth-surfaced bladder tumescence of approximately 30 and 7 mm in diameter. Biopsy of the tumor and other apparently normal epithelium revealed dense lymphocytic infiltrations with formation of many lymph follicles. Because of the relatively large nodular form of the lesion we regarded this to be pseudolymphoma of the bladder rather than follicular cystitis. Pseudolymphoma in the bladder has not yet been reported in English literatures to our knowledge. The tumorous changes have disappeared by 6 months after the initial 3 week chemotherapy.

T-zone histiocytes and recurrence of papillary urothelial bladder carcinoma.

We have studied the histologic distribution and prognostic significance of T-zone histiocytes (TZH) in 89 papillary urothelial bladder carcinomas (PUC), 3 cases of nonspecific cystitis (NC) and 4 cases of follicular cystitis (FC) by immunohistochemical determination of S-100 protein. Nineteen (21.37%) of the PUC cases have been found to have TZH S-100-positive with a variable density intratumor, along the papillary axis, or in the lymphoid aggregates of the vesical wall. All four FC cases were also TZH-positive, with a distribution and density similar to those of follicular dendritic cells of lymph nodes, although none of the 3 NC cases presented TZH. The recurrence-free period was significantly (p less than 0.05) longer in TZH-positive patients.

Granular cystitis in girls. Long-term follow-up.

Granular cystitis or 'papular cystitis' is a very common form of cystitis in young girls. In this paper we show the evolution of this affliction in women after puberty. In a series we were able to follow up leukoplakia or follicular cystitis patients to the age of 16 years.

Chronic toxicity of ponceau SX to rats, mice, and dogs

Summary Groups of 24 Osborne-Mendel rats, evenly divided by sex, were fed laboratory chow diets containing 5.0, 2.0, 1.0, 0.5, or 0.0% Ponceau SX for two years without significant effect on growth, survival, hematologic values, organ weights at autopsy, or gross and microscopic pathologic findings. No tumorigenicity was observed in tests in which a total of 2400 rats and mice of two strains each were subjected to two-year feeding and subcutaneous injection tests for carcinogenicity of Ponceau SX. Ponceau SX when fed to dogs at a 2% level in a commercial laboratory chow caused the death of one of three dogs in a preliminary study and of three of five dogs in a seven-year study. A second group of five female dogs tolerated Ponceau SX at 1% in the diet for seven years without effect on hematologic values or weight gains, but their food consumption was slightly increased during the critical first 6 months on test. Canine lesions attributable to toxicity of this color were moderate to marked atrophy of the adrenal zona glomerulosa, chronic follicular cystitis with hematomatous projections into the urinary bladder, and small hemosiderotic foci in the liver.