Follicular cystitis is a review of the literature with several cases...
A broad range of diseases are described in cystitis.Dysuria, frequency, urgency, and suprapubic pain are the leading symptoms.Infections of the lower genitourinary tract, such as bladder carcinoma, urethral diverticulum, and calculi, may also be associated with these symptoms.
Different types of cystitis are more common in the affected patient population.Acute cystitis is the most common cause of urinary tract infections in sexually active women.About 20 cases of xanthogranulomatous cystitis have been reported.[3]
Radiation cystitis, for example, has a high incidence in a particular patient population or a unique geographic distribution.It is common in Africa and the Middle East.
Infections through the urethra caused by the patient's own enteric microbiota are the most common cause of cystitis.Hematologic dissemination of organisms in patients is possible.coliform Escherichia coli, Proteus, Klebsiella, and Enterobacter are some of the most common pathologic agents.The presence of Bacteroides fragilis suggests that there is communication between the urinary tracts.
The lower genitourinary tract is frequently associated with infections with the obligate intracellular organisms.It has been linked to painful bladder syndrome.Acute inflammation can be caused by Fungi and Viruses, mainly in patients who are immune suppressed.
Emphysematous cystitis is characterized by gas-filled cysts in the bladder wall.Poorly controlled diabetes, chronic cystitis, neurogenic bladder, and immunocompromise are usually associated with this entity.[5]
A common finding is cystitis cystica et glandularis.It has been linked to long-standing mucosal irritation.This condition is thought to be fixed with the elimination of the provoking cause.The association between the two has not been proven.[5]
A rare condition called eosinophilic cystitis can be associated with a number of diseases.
Follicular cystitis can be seen in the background.The underlying cause can be infectious, such asSalmonella in the urinary tract, but can also be seen with BCG therapy after transurethral resection of the appendix.
Granulomatous inflammation can be caused by a variety of infections.In the bladder, it arises from the treatment of high-grade papillary carcinoma or carcinoma in situ or following transurethral resection of bladder tumors.The most common cause of Granulomatous cystitis is the Tuberculosis.
If it is combined with radiation therapy, classic hemorrhagic cystitis is often seen as a side effect of cyclophosphamide.There is a link between ometrexate therapy and hemorrhagic cystitis.In immunocompromised patients, viral infections, such as with adenoviruses, may result in a similar clinical presentation.
Middle-aged white women are more affected by this form of cystitis than the Jewish population.The cause of interstitial cystitis is not fully understood.Epidemiologic studies show that affected individuals are more likely to have a history of bladder problems.
It has been shown that the prevalence of certain diseases is higher in this patient group.Twin studies suggest that genetics may play a role in the development of cystitis.On 12 and 13
Other etiologies include an infectious agent or a defect in the epithelial cell layer, which allow toxic substances to enter the bladder wall and cause symptoms.Alterations in the central nervous system and mast cells have been proposed as possible causes of interstitial cystitis.[14, 15, 16]
In a study designed to identify toxic factors, the patients with IC had more urinary cationic metabolites than the control group.HTB-4 urothelial cells were used to determine cytotoxicity.The cytotoxicity of the cationic metabolites in patients with IC was higher than in the control subjects.[17]
There is a rare, nonspecific mucosal reaction that occurs after chronic inflammation of the bladder.There is a chronic phase of cystitis.
Frequent bladder catheterization has been linked to the development of papillary cystitis.Middle-aged men are the majority of patients.
Rapid cell death may be caused by radiation.Vein changes can be caused by radiation.The proliferation and swelling of theendothelial may deplete the blood supply to the irradiated tissue.
It can take as long as 14 years for radiation cystitis to develop.The severity of the disease depends on the dose and duration of exposure.
The GU tract is home to an unusual process called Malakoplakia.It is more often seen in women.Malakoplakia is thought to be the result of a defect in histiocytes' phagolysosomal activity.The histiocytes are where the calcium and iron are deposited.
The trematode flatworm Schistosoma haematobium is found in Africa and the Middle East.Humans become sick from contact with contaminated water and the parasites that live in it.The adult form of the parasites resides in the bladder wall.Eggs released by the adult worm can cause inflammation and ulceration.
There is a rare, benign, inflammatory condition called Xanthogranulomatous cystitis.The condition has been linked to the following.
The findings are not specific to cystitis.cystoscopic examination can show the findings of edema, hyperemia, petechiae, hemorrhage, or ulceration.Specific findings include the following:
Rarely, papillary fronds are seen in cystitis cystica and glandularis.
Follicular cystitis may include mass lesions, yellow plaques, and surface erythema.
Papillary projections are thin and delicate in papillary cystitis.
The use of urine in differentiating different types of cystitis is limited.The main purpose of urine cytology is to rule out malignancy; it can also be useful in guiding the clinician to the correct diagnosis of certain infectious processes.
Chronic and recurrent cases may need histologic evaluation to rule out underlying malignancy, which is why tissue sampling in the acute phase of infectious cystitis is not advisable.The findings are nonspecific acute and chronic inflammatory infiltrate in the lamina propria.The overlying epithelium may have different degrees of reactive atypia.[22]
It's much more universal to look at the urine.Atypical urothelial cells and necrotic debris can be found along with the typical inflammatory cells.The following cytopathic effects can be appreciated in viral cystitis.
There are parasites that can be seen in urine specimen.[23]
Emphysematous cystitis is caused by gas-filled spaces in the bladder wall.The cysts are lined with giant cells.
The image below shows the von Brunn nest in the lamina propria developing slitlike and cystic spaces.The spaces may be surrounded by a ring of transitional epithelium.
The cystitis glandularis of the common type have a low columnar lining.The less common form of cystitis glandularis is the intestinal variety.The glands are lined with columnar epithelium with abundant mucin.goblet cells, Paneth cells and argentaffin cells may be present.
Compared to adenocarcinoma, cystitis glandularis of the intestinal type has more superficial and evenly spacing glands in the lamina propria.There may be extracellular mucin pools in both scenarios.There are no floating epithelial clusters in cystitis glandularis.Careful examination for features of malignancy is necessary for adenocarcinoma to arise from long-standing cystitis glandularis.[ 24]
The nested variant of von Brunn nest may be difficult to differentiate from urothelial carcinoma.The smooth, round shape of the nest, consisting of numerous cells, with no atypia, supports the diagnosis of CCCG.It has to be noted that reactive atypia may be present in von Brunn nest and also in the surface epithelium.
The cystitis is characterized by a dense, mixed, chronic inflammatory infiltrate in the bladder wall.Muscle necrosis and Fibrosis may also be present.Invasive transitional cell carcinoma has similar histologic findings.[25]
The images below show a special form of chronic cystitis that shows lysoid aggregates with germinal centers in the lamina propria.
The histologic features of cystitis are dependent on the cause.There are cases of granulomas with giant cells in the lamina propria.It is possible that mucosal ulceration is also present.The presence of noncaseating granulomas with the background of acute and chronic inflammation and superficial ulceration is suggestive of BCG treatment.
Postresection changes can lead to the formation of foreign body–type granulomas.There are special stains that can be used to determine the underlying cause.
Hemorrhagic cystitis is caused by the denudation of the surface epithelium.There may be fibrinopurulent exudate present.Edema and hemorrhage can be seen in the lamina propria.
Interstitial cystitis requires strong clinical correlation to be a diagnosis.The histologic findings involve the muscularis propria and nerves.There may be bladder inflammation, urothelium denudation, eosinophil and plasma cell infiltration, and lamina propria hemorrhage.Mast cells are usually present in the bladder wall and bladder washing specimen.It is a classic finding but not always present.The key from the histologic aspect is to rule out other conditions.
Fingerlike projections can be thin and delicate, representing the morphologic spectrum of papillary-polypoid cystitis.The urothelium is lined with umbrella cells.
There is a variable amount of chronic inflammatory infiltrate in the underlying lamina propria.The inflammation is helpful to make a distinction between this entity and papillary urothelial carcinoma, in which inflammation in the lamina propria is not present.[ 24]
Nonspecific acute and chronic inflammation, dilated blood vessels, hemorrhage, and edema are some of the symptoms of radiation cystitis.Microthrombi and fibrin deposition are often present in the endothelial cells.
The presence of atypical fibroblasts suggests a long-standing process.cytoplasmic vacuolization and karyorrhectic debris can be seen in the surface epithelium.
The pseudocarcinomatous proliferation composed of irregularly shaped aggregates of epithelial cells in the lamina propria with or without atypia is an emphasized radiation-related injury of the bladder.There are small projections of the nest with surrounding artifacts around it.For an extended period after treatment completion, radiation-related changes may persist.
There are sheets of epithelioid histiocytes, which are sometimes multinucleated giant cells.The histiocytes can be highlighted with iron and calcium stains because of their characteristic round, laminated, intercytoplasmic inclusions.Michaelis-Gutmann bodies are filled with undigested bacterium and are considered pathognomonic for the disease.
Eggs in the veins of the muscularis propria can be seen with schistosomiasis-associated cystitis.Inflammation and ulceration may also be present.
A foreign body–type reaction in association with fibrosis is what dominates the picture later on.The assessment of the mucosa is important because schistosomiasis has a strong association with bladder cancer.
In xanthogranulomatous cystitis, there are sheets of macrophages in the propria.There may be chronic suppurative infections in the background.xanthogranulomatous cystitis can cause foamy histiocytes, multinucleated giant cells, and cholesterol clefts in the bladder wall.
This condition is associated with two types of cancer, urachal adenocarcinoma and transitional cell carcinoma.When this rare diagnosis is made, the occurrence of related neoplasm should be considered.[20]
If a differential diagnostic dilemma arises,immunohistochemistry may be helpful.Diagnostic changes in viral cystitis can be confirmed with immunohistochemical staining.
It can mimic follicular or chronic cystitis.A panel of studies may be required to exclude diseases.[28]
A study suggests that certain genes in the Toll-like receptor pathway are associated with increased susceptibility to recurrent urinary tract infections in adult women.[29]
Gene expression profiles from bladder biopsies show a similar expression pattern to those of patients with immune system and other diseases.The majority of the genes that were upregulated were found in the leukocytes.30
The aldehyde dehydrogenase gene family has been linked to an increased risk of developing cystitis and liver toxicity in patients treated.[31]
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