Inflammatory Bladder Lesions Flashcards

1
Q

What is CCEG, and what causes it?

A

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.

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2
Q

What are the symptoms and common locations of CCEG?

A

Common in adults; can also occur in children.
Typical symptoms: irritative LUTS and hematuria.
Common locations: trigone, bladder neck, lateral bladder walls, posterior urethra.

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3
Q

Is CCEG associated with urothelial malignancy, and what’s the follow-up?

A

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.

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4
Q

What are the treatment options for CCEG?

A

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.

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5
Q

What is the mechanism of action of sodium hyaluronate in treating CCEG?

A

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.

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6
Q

What is EC, and what does it look like?

A

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.

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7
Q

Who does EC affect, and what are the symptoms?

A

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.

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8
Q

What are the treatment options for EC?

A

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.

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9
Q

What is Polypoid Cystitis, and what causes it?

A

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.

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10
Q

Who does Polypoid Cystitis affect, and what are the symptoms?

A

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.

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11
Q

What are the treatment options for Polypoid Cystitis?

A

Treatment usually involves transurethral resection of the mass.
Treatment of the underlying condition, if possible.
Short-term corticosteroids have been used successfully.

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12
Q

What is HL IC, and what does it look like?

A

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.

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13
Q

Who does HL IC affect, and what are the symptoms?

A

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.

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14
Q

What are the treatment options for HL IC?

A

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).

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15
Q

What is Polyomavirus Cystitis, and what does it look like?

A

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.

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16
Q

Who does Polyomavirus Cystitis affect, and what are the symptoms?

A

BK virus is one type; seroprevalence rates of 80%–90% by adulthood.
Reactivated in 2%–66% of patients receiving allogeneic hematopoietic stem cell transplant.
Mean time to cystitis after transplantation: 34 days.
Symptoms: gross hematuria, bladder/pelvic pain, viruria; may increase mortality risk.

17
Q

What are the treatment options for Polyomavirus Cystitis?

A

Prevention: hyperhydration; fluoroquinolones as prophylaxis (last resort).
Treatment for gross hematuria: continuous bladder irrigation (not reducing risk).
Successful use of Cidofovir, hyperbaric oxygen, intravenous leflunomide, vidarabine, topical hemostatic agents, factor VIII concentrate, estrogens.
Cystectomy is rare; reduction in immunosuppressive meds not shown to improve.

18
Q

What is Malakoplakia, and what does it look like?

A

Malakoplakia: yellow to tan plaque, later grey/tan with central depression.
Associated with poor bacterial phagocytosis; multiple bacteria associated.
Microscopically shows histiocytes (von Hansemann cells), Michaelis-Guttman bodies.
May be mistaken for or accompany transitional cell carcinoma.

19
Q

Who does Malakoplakia affect, and what are the symptoms?

A

Male-to-female ratio 1:4; often in immunosuppressed individuals.
Can involve any organ of the genitourinary tract; symptoms include bladder pain, urgency, frequency, flank pain.
Associated with autoimmune disorders, neoplastic processes, tuberculosis, alcohol abuse, diabetes, ulcerative colitis, malnutrition.
Can cause hydronephrosis and renal failure.

20
Q

What are the treatment options for Malakoplakia?

A

Treatment depends on extent; hydronephrosis addressed with stents or nephrostomy drainage.
Bladder lesion needs biopsy and resection if possible.
Medical management with antibiotics like quinolones and sulfonamides.
Long-term use of fluoroquinolones with caution; minimize immunosuppression if possible.

21
Q

What is Nephrogenic Adenoma, and what does it look like?

A

Relatively rare lesion from renal cells implanting in the bladder.
Cystoscopically, appears papillary; can be confused for urothelial carcinoma.
Microscopically shows cuboidal/flat epithelial cells; can mimic prostatic adenocarcinoma.
Immunoreactive for cytokeratin, PAX-2, PAX-8; low proliferation rate.

22
Q

Who does Nephrogenic Adenoma affect, and what are the symptoms?

A

More common in males (2:1, male:female).
Symptoms include hematuria and/or LUTS.
Risk factors: prior bacillus Calmette-Guérin therapy, recurrent UTI, chronic catheterization.
Most commonly affects bladder neck, urethra, ureter, renal pelvis.

23
Q

What are the treatment options for Nephrogenic Adenoma?

A

Treatment: surgical (transurethral resection, cystectomy, diverticulectomy).
Sodium hyaluronate used for multifocal disease, decreasing bladder inflammation.
Benign but has a 3%–67% recurrence rate; surveillance cystoscopy recommended.
Urine cytology used for surveillance, depending on PAX-8 staining.

24
Q

What is Follicular Cystitis, and what are its characteristics?

A

Unknown cause but associated with inflammatory conditions and infections.
Cystoscopically appears flat, papillary, nodular, erythematous, velvety.
Microscopically shows lymphoid aggregates with germinal centers in bladder lamina propria.

25
Q

Who is affected by Follicular Cystitis, and what are the symptoms?

A

More common in women over 50.
Symptoms: frequent urination, dysuria, hematuria, recurrent UTI.
Risk factors: bladder stones, bladder malignancy, history of bacillus Calmette-Guérin therapy.
Urine cytology may reveal lymphocytic aggregates.

26
Q

What are the treatment options for Follicular Cystitis?

A

Treatment: removal of infectious or inflammatory processes.
Long-term suppressive antibiotics or urinary antisepsis; anti-inflammatory meds, corticosteroids, vitamin A.
Other treatments: diethylcarbamazine, pentosan polysulfate sodium, dimethyl sulfoxide, amitriptyline, duloxetine, radiotherapy.
For bulky disease: transurethral resection or palliative cystectomy.

27
Q
A