A case of cystitis cystica and glandularis suspected of submucosal tumor of urinary bladder

A case of cystitis cystica and glandularis is reported. The patient visited our hospital with the complaint of terminal miction pain. Cystoscopic examination showed a walnut-sized, well-defined mass in the retrotrigone. The surface of the mass was nodular and partially cystic. Computer tomography showed a mass protruding inside and outside of the bladder. Transurethral biopsies of the mass revealed cystitis cystica and glandularis.     

A case of cystitis glandularis. Its relationship to bladder carcinoma

A 41-year-old male was admitted to the hospital for frequent urination and severe retardation before voiding. Roentgenography revealed exophytic lesions which were located mainly in the trigone of the bladder, and he underwent transurethral resection. The pathological diagnosis was cystitis glandularis. There was no literature which reported cystitis glandularis causing urinary disturbance. This case, moreover, had been diagnosed as cystitis glandularis 13 years before by endoscopical biopsy. The origin of cystitis glandularis and its potentiality as a pre-malignant lesion were discussed from the clinical course for over 10 years.     

Single polypoid cystitis cystica and glandularis presenting as benign bladder tumor

A case report of a ten-year-old boy with a benign polypoid bladder tumor is presented. The rarity of benign or malignant bladder tumors in children is reviewed, as well as the possible etiology of this unique lesion.     

腺性膀胱炎伴发膀胱肿瘤的诊断及治疗(附1例报告)

目的 探讨腺性膀胱炎伴发膀胱肿瘤的临床诊断及治疗.方法 回顾性分析1例腺性膀胱炎伴发膀胱肿瘤患者的临床资料:患者女性,49岁,因尿频和反复发作性肉眼血尿就诊.既往有卵巢囊肿行右侧卵巢切除术,及子宫内膜异位症行激素替代治疗病史;既往无尿路感染病史,尿检除红细胞阳性外,未见白细胞和非典型细胞;肿瘤标记物检查阴性.膀胱镜检可见膀胱左后壁片状非乳头型黏膜病变,伴蓝色可疑子宫内膜异位灶;CT平扫见膀胱左后壁直径3cm密度增强的类圆形病灶.行经尿道膀胱新生物电切术.结果 术中快速冰冻及术后活检示Brunn's nests伴腺性化生、腺性膀胱炎、局灶性囊性膀胱炎(可见炎性细胞浸润),未见恶性细胞.术后患者恢复良好,随访至今膀胱肿物明显缩小,未行相关肿瘤学治疗.结论 腺性膀胱炎伴发膀胱肿瘤者应完善检查综合分析,考虑非恶变肿瘤者可仅行经尿道电切术,但术后应定期复查、加强随访.     

Pelvic lipomatosis with cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder: first reported case

Pelvic lipomatosis is a rare disease which may cause obstructive uropathy. It has been reported with cystitis cystica and cystitis glandularis. Cystitis cystica and cystitis glandularis have been reported previously as progressing to adenocarcinoma of the bladder. The first reported case of pelvic lipomatosis, cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder is presented and the literature reviewed.     

腺性膀胱炎合并膀胱过度活动症的诊治分析

目的探讨腺性膀胱炎合并膀胱过度活动症的临床诊断与治疗。方法回顾分析2007年1月~2009年10月收治的132例经病理确诊的腺性膀胱炎患者的临床资料。结果 132例患者随访3~28月,治愈85例（68.7%）,好转38例（24.9%）,未愈9例（6.4%）;合并有膀胱过度活动症34例,经托特罗定治疗2周后26例尿急、尿频、夜尿好转,4例急迫性尿失禁缓解,4例治疗后无效,加用盐酸坦索罗辛缓释胶囊治疗2周后症状缓解。结论经尿道电切术联合化疗药膀胱灌注治疗腺性膀胱炎疗效满意,但不能忽视合并有膀胱过度活动症的诊断与治疗。     

A rare case of recurrent urinary obstruction and acute renal failure from cystitis cystica et glandularis

We report a rare case of recurrent florid cystitis cystica et glandularis (CCEG), common type, causing obstruction of the left ureterovesicle junction (UVJ) leading to renal colic and hydronephrosis. A 43-year-old man was admitted with renal colic, left UVJ obstruction, left hydronephrosis and azotemia. Cystoscopy showed a >4-cm bladder lesion compressing the left UVJ. Transurethral resection of the bladder tumour (TURBT) was performed and pathology revealed the lesion as CCEG. Two months later, the CCEG recurred and caused left UVJ obstruction a second time, requiring TURBT.     

膀胱镜对腺性膀胱炎的诊断价值(附11例误诊分析)

目的为提高腺性膀胱炎诊治的水平,减少误诊误治。方法收集5年来误诊误治患者病例资料,总结分析误诊误治的原因。结果本组15例误诊11例,误诊率73%(11/15),误诊时间3个月~4年。结论对本病认识不足是误诊的主要原因,提高对本病的认识、准确的膀胱镜检查和组织活检诊断是病情早期诊断的关键,经尿道电灼后间断膀胱灌注抗肿瘤药物是治疗腺性膀胱炎的主要方法。     

A case of neuroendocrine tumor of the urinary bladder

We present a case of a neuroendocrine tumor of the urinary bladder. A 81-year-old-man presented with macrohematuria and difficult voiding. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed non-papillary broad-based bladder tumor, benign prostatic hyperplasia and three bladder stones. Histological diagnosis was neuroendocrine tumor of the urinary bladder and he underwent two courses of trans-arterial infusion (neoadjuvant) chemotherapy. After two courses of chemotherapy, pelvic CT scan revealed partial response and then the patient underwent transurethral resection of the bladder tumor, simultaneously with TUR-P and cystolithotripsy. Examination of the resected specimen indicated pathological complete remission and he discharged. Although the patient was followed-up postoperatively because of pathological complete response, the tumor recurred in the bladder three months later.     

A case of secondary malignant lymphoma of the urinary bladder

A 56-year-old man was admitted to our hospital for salvage chemotherapy of recurrent diffuse large B cell malignant lymphoma at clinical stage IIIb and which had been treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Computed tomography showed multiple tumors in the bladder after a cycle of ifosfamide, etoposide and mitoxantrone (MINE), but cystoscopy after the second cycle revealed a single non-papillary tumor about 1cm in diameter. After 3 cycles of MINE therapy, transurethral resection of bladder tumor was performed. At the time of the operation, the protruded lesion disappeared and there remained only a scar. Biopsy of the scar revealed malignant lymphoma infiltrated into the submucosal layer. Although the rate of the bladder involvement of malignant lymphoma reaches 3-20% in autopsy cases, it is very rare for a secondary malignant lymphoma of the urinary bladder to be diagnosed clinically. The prognosis of the secondary bladder lymphoma is much poorer than that of the primary one, because of the widespread dissemination of the disease at the time of diagnosis.     

A case of malignant pheochromocytoma of the urinary bladder]

A 31-year-old man was admitted to our hospital because of miction pain and gross hematuria in August, 1988. Cystoscopic examination revealed a solid mass in the bladder. The histological diagnosis was pheochromocytoma of urinary bladder by biopsy. He had a history of syncope on urination several times. Abnormal elevation of serum noradrenaline was observed in hormonal studies and abnormal accumulation was seen in the bladder by 131I-MIBG scintigraphy. Total cystectomy, lymphadenectomy and urinary diversion were performed in November, 1988. Pathological diagnosis was pheochromocytoma of the urinary bladder with metastasis to both iliac lymph nodes.     

A case of primary malignant lymphoma of the urinary bladder

This paper presents an autopsy case of primary malignant lymphoma of the urinary bladder. The patient, a 63-year-old man, consulted us because of macroscopic hematuria. Cystoscopy revealed a bladder tumor, which was diagnosed as an anaplastic cell carcinoma by transurethral punch biopsy. The tumor progressively increased in size, despite treatment with preoperative antineoplastic chemotherapy consisting of CDDP. Only ureterocutaneostomy and biopsy were performed at the operation although total cystectomy and ileal conduit had been planned, because the tumor had invaded into the perivesicular tissue. Biopsy revealed B cell lymphoma, which was characterized by specific staining with IgG by the PAP method. Although antineoplastic chemotherapy was performed again after operation, the patient gradually weakened and died 5 months after admission. At autopsy, a hen-egg sized, non-papillary tumor which invading into the perivesicular tissue was found at the anterior wall of the urinary bladder. There were many metastatic nodules in the thraco-lumbar vertebral columns, para-aortic lymphnodes and mesenteric lymphnodes. Lungs and liver were free from metastatic tumors.     

A case of secondary malignant lymphoma of the urinary bladder

A case of secondary malignant lymphoma of the urinary bladder is presented. Clinical diagnosis was metastatic small cell carcinoma in urinary bladder. Pathological diagnosis after autopsy, however, revealed vesical involvement of malignant lymphoma. The primary focus was considered to be the lung, the biopsy specimen of which was initially diagnosed as small cell carcinoma, because clinical manifestation first occurred in the lung and the metastasis to subcutaneous tissue, bladder and other abdominal organs was found subsequently. In a study of secondary involvement of genitourinary organs as seen in the present case, we reviewed 303 patients who had died of malignant lymphoma at our institute between 1960 and 1985.     

Pelvic lipomatosis associated with cystitis glandularis and adenocarcinoma of the bladder

Pelvic lipomatosis is a rare condition characterized by an overgrowth of normal fat in the perivesical and perirectal spaces. Cystitis glandularis, cystica or follicularis has been observed in 75% of the patients with pelvic lipomatosis. Although cystitis glandularis is widely regarded as premalignant few reports have documented its transition to adenocarcinoma. We describe a 41-year-old man with pelvic lipomatosis in whom primary adenocarcinoma of the bladder developed 6 years after a histological diagnosis of cystitis cystica and glandularis was established. To our knowledge this is the second case reported of pelvic lipomatosis associated with proliferative cystitis and adenocarcinoma of the bladder, indicating that intestinal metaplasia of the urothelium may be a precursor of malignancy in these patients.     

伴有上尿路梗阻的腺性膀胱炎的临床特征

目的探讨伴有上尿路梗阻的腺性膀胱炎的临床特征。方法70例伴有上尿路梗阻的腺性膀胱炎与60例无上尿路梗阻的腺性膀胱炎进行比较,观察2组在临床表现和手术疗效方面的差异。结果伴有上尿路梗阻的腺性膀胱炎女性发病率高于男性,发病年龄低于无上尿路梗阻组。临床表现主要为肾区或腹部疼痛,少数患者同时伴有恶心、呕吐、尿频、尿急、尿痛、血尿和发热等,病程一般较短。膀胱镜检查病灶分布特征和尿液细菌培养结果2组之间无差异。伴有上尿路梗阻组没有二次手术病例,无上尿路梗阻组有9．3％患者需进行二次以上的手术。结论伴有上尿路梗阻的腺性膀胱炎通常以上尿路梗阻症状为主要临床表现。治疗时首先应明确和解除输尿管梗阻的原因。对于腺性膀胱炎,应进行积极治疗或密切随访。     

A case of inflammatory myofibroblastic tumor of the urinary bladder

A 61 year-old man complaining of asymptomatic gross hematuria was admitted to our hospital in May 2005. Transurethral resection of bladder tumor (TUR-BT) was performed for a bladder tumor (urothelial carcinoma (UC), pTa, G2). The TUR-BT was performed again because cystoscopy revealed a nonpapillary bladder tumor on the posterior bladder wall in September 2007. The pathological findings showed a UC, pTa, G2 and an inflammatory myofibroblastic tumor (IMT), pT1. The TUR-BT was performed two more times for tumor recurrences. We considered a total cystectomy because of the possibility of a pathologically low grade sarcoma and the considerable enlargement of the tumor size for a month after the TUR-BT. Ultimately, a malignant sarcoma was not diagnosed from the pathological findings. We practiced conservative therapy with a steroid and the tumor was reduced.     

The role of beta-catenin signaling in the malignant potential of cystitis glandularis

PURPOSE: Chronic inflammation is a risk factor for malignant transformation in the bladder. The pro-inflammatory cytokine tumor necrosis factor-alpha (TNFalpha) is a mediator of such inflammation that induces nuclear localization of the adherens junction component beta-catenin. This mechanism has a key role in the initiation and progression of the premalignant lesion Barrett's metaplasia of the esophagus. Cystitis glandularis is a metaplastic lesion of the bladder urothelium occurring in the presence of chronic inflammation and in up to 13% of asymptomatic bladders. Two subtypes are described (typical and intestinal/colonic) with uncertain malignant potential. Etiologically and histologically cystitis glandularis mimics Barrett's metaplasia. We investigated the roles of beta-catenin and TNFalpha in cystitis glandularis. MATERIALS AND METHODS: Immunohistochemistry and immunofluorescence were used to demonstrate the expression and localization of E-cadherin, beta-catenin and TNFalpha in 9 sections of typical cystitis glandularis and 4 of intestinal/colonic cystitis glandularis. Appropriate controls were used for all experiments. RESULTS: Immunohistochemistry demonstrated normal membranous expression of E-cadherin and beta-catenin in all cystitis glandularis sections with increased TNFalpha expression. Immunofluorescence showed nuclear localization of beta-catenin in the intestinal/colonic subtype only, which was not observed in typical cystitis glandularis. CONCLUSIONS: The presence of nuclear beta-catenin suggests that intestinal/colonic cystitis glandularis shares the same signaling pathway with the premalignant lesion Barrett's metaplasia of the esophagus and the intestinal/colonic subtype of cystitis glandularis may have the potential to progress to malignancy. This finding has important implications for the management of this lesion.