Acute & chronic cystitis

Know the etiology and pathology of cystitis including follicularis, eosinophilic, cystitis cystica and cystitis glandularis variants. Which group of pts is more predisposed to Candida and cryptococcal cystitis?

• etiological agents--coliforms (E. coli, Proteus, Klebsiella, Enterobacter), Tuberculous cystitis (often after renal tuberculosis), Candida albicans, & rarely cryptococcal agents (esp. immunosuppressed pts & pts on long term antibiotics), Schistosomiasis (rare in U.S., but common im Middle Eastern countries, esp. Egypt ), viruses (adenovirus), Chlamydia, Mycoplasma, cyclophosphamide (hemorrhagic cystitis), radiation of bladder (radiation cystitis)

• follicular cystitis--characterized by aggregation of lymphocytes into lymphoid follicles w/in the bladder mucosa & underlying wall

• eosinophilic cystitis--manifested by infiltration w/submucosal eosinophils together w/fibrosis & occasionally giant cells

• cystitis glandularis & cystitis cystica--common lesions of bladder where nests of transitional epithelium (Brunn nests) grow downward into the lamina propria & undergo transformation of their central epithelial cells into cuboidal or columnar epithelium lining slitlike (cystitis glandularis) or cystic spaces (cystitis cystica); incidental finding, common in relatively normal bladders, more common in chronically irritated & inflamed bladders. Lesions w/extensive intestinal metaplasia  increased risk of adenocarcinoma

Know the causes of hemorrhagic cystitis.

• cyclophosphamide, radiation injury, adenovirus

Know the clinical manifestations of cystitis.

• triad of sx: 1) frequency 2) lower abdominal pain localized over superpubic region 3) dysuria

What is interstitial cystitits?

• Hunner ulcer--persistent, painful form of chronic cystitis occurring most frequently in females & assoc. w/inflammation & fibrosis of all layers of the bladder wall; etiology is unknown but some think it is autoimmune

Know the pathology and pathogenesis of malakoplakia.

• peculiar pattern of vesical inflammatory reaction characterized macroscopically by soft, yellow, slightly raised mucosal plaques 3-4cm in diameter & histologically by infiltration w/ large foamy macrophages w/occasional multinucleate giant cells & interspersed lymphocytes; Michaelis-Gutmann bodies typically present; related to chronic bacterial infections (mostly E. coli, sometimes Proteus); increased frequency in immunosuppressed transplant recipients.

Know the pathology of cystitis cystica and cystitis glandularis.

• see #5 and also in cystitis cystica, cysts are usually 0.1-1cm w/clear fluid

Category: Pathology Notes