Inflammatory Bladder Lesions Flashcards
What is CCEG, and what causes it?
CCEG (Cystitis Cystica et Glandularis) is a chronic reaction in the bladder.
Often caused by bladder irritation from recurrent UTIs, tumors, stones, or outlet obstruction.
It forms single or multiple submucosal nodules in the bladder.
What are the symptoms and common locations of CCEG?
Common in adults; can also occur in children.
Typical symptoms: irritative LUTS and hematuria.
Common locations: trigone, bladder neck, lateral bladder walls, posterior urethra.
Is CCEG associated with urothelial malignancy, and what’s the follow-up?
Unclear association with malignancy; retrospective reviews indicate higher risk.
Cystoscopic follow-up recommended, but timing and duration are unclear.
Continued surveillance if bladder irritation is ongoing.
What are the treatment options for CCEG?
Remove the source of irritation.
Administer antibiotics, nonsteroidal anti-inflammatory drugs, steroid pulse therapy, antihistamines.
Transurethral resection and fulguration for symptomatic lesions.
Newer therapies like sodium hyaluronate.
What is the mechanism of action of sodium hyaluronate in treating CCEG?
Sodium hyaluronate repopulates the glycosaminoglycans layer (GAG) of the urothelium.
In animal models, shown to block the effects of interleukin-6 (IL-6) and downregulate the JAK2/Stat3 pathway.
Leads to decreased inflammation and helps resolve CCEG.
What is EC, and what does it look like?
EC presents as diffuse inflammation or pseudotumor (20% of cases).
Lesions appear inflammatory, edematous, ulcerated, or necrotic.
Characterized by inflammation of the lamina propria with eosinophilic component.
Common mutation: BRAF mutation; potential serum marker.
Who does EC affect, and what are the symptoms?
Rare disease; around 200 cases described.
Affects children/young women and middle-aged men.
Symptoms: hematuria and irritative LUTS.
May show hydronephrosis on imaging; bladder lesions or wall thickening.
What are the treatment options for EC?
Diffuse EC: oral corticosteroids, nonsteroidal anti-inflammatory drugs, antihistamines, azathioprine.
Pseudotumoral form requires different protocols; removal of allergens.
Transurethral resection or cystectomy in refractory cases.
Successful therapy with benralizamab, an interleukin-5 inhibitor.
What is Polypoid Cystitis, and what causes it?
Polypoid Cystitis is an inflammatory reaction to bladder injury.
Typical causes: indwelling catheters, stones, fistulae, pelvic abscess, or bladder outlet obstruction.
Lesions appear papillary, broad, and edematous; can be large (up to 6 cm).
Microscopically lacks complex branching and true fibrovascular cores; may show urothelial hyperplasia, inflammation, and reactive atypia.
Who does Polypoid Cystitis affect, and what are the symptoms?
No specific age preference; reported even in neonates.
More common in males; often linked to a history of catheterization.
Symptoms may include irritative LUTS or hematuria.
Imaging may show a bladder mass; hydronephrosis/ureteral obstruction described.
What are the treatment options for Polypoid Cystitis?
Treatment usually involves transurethral resection of the mass.
Treatment of the underlying condition, if possible.
Short-term corticosteroids have been used successfully.
What is HL IC, and what does it look like?
HL IC presents as a reddened area with small vessels radiating toward a central scar.
Two categories: inflamed (friable, red) and noninflamed (white, scarred).
Microscopically shows ulceration, inflammation, granulation, fibrosis, edema, and mast cell infiltrate.
Associated with higher urinary levels of pro-inflammatory cytokines and nitric oxide.
Who does HL IC affect, and what are the symptoms?
Mostly affects females; 5%–57% of patients with interstitial cystitis have HL variant.
Symptoms: older age, more frequency, reduced bladder capacity, sharp and stabbing pain.
Co-existence with autoimmune disorders like Sjogren’s syndrome, lupus, rheumatoid arthritis.
Larger lesions correlate with worse symptoms.
What are the treatment options for HL IC?
Responds well to endoscopic treatments: triamcinolone injection, fulguration.
Hydrodistension recommended to delineate lesion borders.
Up to 90% have symptom relief; 40% lasting up to 3 years.
Oral cyclosporine A effective; nitric oxide pathway may offer a new treatment.
Rarely, urinary diversion needed; risks include bladder perforation (rare).
What is Polyomavirus Cystitis, and what does it look like?
Polyomavirus Cystitis is linked to urothelial lining damage by oncologic conditioning regimens.
Microscopically shows urothelial cells with viral inclusions; “decoy cells” can mimic urothelial carcinoma.
May lead to denuding of urothelium, inflammation, and hemorrhage.
Cystoscopically shows diffusely inflamed bladder with hemorrhage and erosion.