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Polypoid Cystitis Mimicking Transitional Cell Carcinoma
0022-534'?/84/1315-0963~02.00/0 VoL
THE .JOURNAL OF UROLOGY
Printed in
Copyright© 1984 by The Williams & \iVilkins Co.
POLYPOID CYSTITIS MIIVIICKING TRANSITIONAL CELL CARCINOMA EDWARD G. BUCK From the Urology Service, Fitzsimons Army Medical Center, Aurora, Colorado
ABSTRACT
A case of polypoid cystitis without a history of catheterization and grossly mimicking papillary transitional cell tumor is reported. Polypoid cystitis is recognized frequently in patients with indwelling catheters but has not been reported in the absence of a catheter or hematuria and dysuria. The term refers to edema, congestion and inflammation elevating the vesical mucosa into papillary projections. Epithelial metaplasia and hyperplasia may occur. Bullous cystitis is a variant with broad, rounded elevations. 1 " Ekelund and Johansson described histologic changes of polypoid cystitis in 40 of 51 patients treated by urethral catheters. 1 Although some had no infection 90 per cent wearing the catheter for >3 months had beginning on the posterior wall. No patient without a catheter had the lesion. Friedman and Ash mentioned a 23-year-old man with dysuria and hematuria who was found to have polypoid cystitis." No mention of catheterization or other trauma was made. Canine polypoid cystitis associated with hematuria and infection has been reported: CASE REPORT
A 67-year-old white man was seen for symptoms of prostatism increasing gradually for >5 years. Nocturia, decreased force of stream and frequency were present but there was no history of instrumentation, catheterization, infection or hematuria. The 45 gm. prostate was benign on palpation. Urinalysis was normal and the urine was sterile. Cystoscopy revealed an obstructive prostatic channel and a l cm. papillary bladder tumor at the bladder neck on the right side. Transurethral resection of the tumor and prostate was done. Followup cystoscopy at 6 months revealed an open prostatic channel and no urothelial abnormalities. The tumor !-'"'~11.ut.u consisted of a LO x 0.4 fragment of gray-tan tissue, part of which vvas b"~u-•u•• nodular. examination revealed ~v• n , v , ~ with fibrovascular stalks, areas of edema matory cells. A transitional cell v,,,v,.,v,.,w.LL with areas of ccq.nanw but
A, photomicrograph of polypoid cystitis. H & E, reduced from B, area of typical stalk with transitional epithelium. H & E,
from
DISCUSSION
X200.
REFERENCES
Urothelial abnormalities in the obstructed bladder with and dysplasia have perplasia, von Brunn's nests, been described." An adenomatous of the bladder thought to rise from ectopic prostatic tissue, has been reported. Polypoid cystitis can be found on the microscopic as well as the grossly visible level. Commonly associated with the catheter, it is as commonly recognized visually and rarely examined histologically. It is believed to be a benign lesion on a spectrum of metaplasia. This case developed as an isolated lesion strongly resembling a transitional cell papilloma and in the absence of obvious trauma. Initial papillary lesions should be harvested
1. Ekelund, P. and Johansson, S.: Polypoid cystitis: a catheter associated lesion of the human bladder. Acta Path. Microbial. Scand., 87 A: 179, 1979. 2. Friedman, N. B. and Ash, J.E.: Tumors of the urinary bladder. In: Atlas of Tumor Pathology. Washington, D. C.: Armed Forces Institute of Pathology, 1st series,sect. VIII, fasc. 31a, p. 76, 1959. 3. Mostofi, F. K.: Potentialities of bladder epithelium. J. Urol., 71: 705, 1954. 4. Johnston, S. D., Osborne, C. A. and Stevens, J.B.: Canine polypoid cystitis. J. Amer. Vet. Med. Ass., 166: 1155, 1975. 5. Ormiston, M. C., Knowles, M. A., Ogbolu, H., Newman, J., Hicks, R. M. and Milroy, E. J. G.: Urothelial abnormalities in the obstructed bladder. Brit. J. Urol., 54: 234, 1981. 6. Rubin, J., Khanna, 0. P. and Damjanov, L: Adenomatous polyp of the bladder: a rare cause of hematuria in young men. J. Urol., 126: 549, 1981.
Accepted for publication January 11, 1984. The assertions or opinions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. 963
THE .JOURNAL OF UROLOGY
Printed in
Copyright© 1984 by The Williams & \iVilkins Co.
POLYPOID CYSTITIS MIIVIICKING TRANSITIONAL CELL CARCINOMA EDWARD G. BUCK From the Urology Service, Fitzsimons Army Medical Center, Aurora, Colorado
ABSTRACT
A case of polypoid cystitis without a history of catheterization and grossly mimicking papillary transitional cell tumor is reported. Polypoid cystitis is recognized frequently in patients with indwelling catheters but has not been reported in the absence of a catheter or hematuria and dysuria. The term refers to edema, congestion and inflammation elevating the vesical mucosa into papillary projections. Epithelial metaplasia and hyperplasia may occur. Bullous cystitis is a variant with broad, rounded elevations. 1 " Ekelund and Johansson described histologic changes of polypoid cystitis in 40 of 51 patients treated by urethral catheters. 1 Although some had no infection 90 per cent wearing the catheter for >3 months had beginning on the posterior wall. No patient without a catheter had the lesion. Friedman and Ash mentioned a 23-year-old man with dysuria and hematuria who was found to have polypoid cystitis." No mention of catheterization or other trauma was made. Canine polypoid cystitis associated with hematuria and infection has been reported: CASE REPORT
A 67-year-old white man was seen for symptoms of prostatism increasing gradually for >5 years. Nocturia, decreased force of stream and frequency were present but there was no history of instrumentation, catheterization, infection or hematuria. The 45 gm. prostate was benign on palpation. Urinalysis was normal and the urine was sterile. Cystoscopy revealed an obstructive prostatic channel and a l cm. papillary bladder tumor at the bladder neck on the right side. Transurethral resection of the tumor and prostate was done. Followup cystoscopy at 6 months revealed an open prostatic channel and no urothelial abnormalities. The tumor !-'"'~11.ut.u consisted of a LO x 0.4 fragment of gray-tan tissue, part of which vvas b"~u-•u•• nodular. examination revealed ~v• n , v , ~ with fibrovascular stalks, areas of edema matory cells. A transitional cell v,,,v,.,v,.,w.LL with areas of ccq.nanw but
A, photomicrograph of polypoid cystitis. H & E, reduced from B, area of typical stalk with transitional epithelium. H & E,
from
DISCUSSION
X200.
REFERENCES
Urothelial abnormalities in the obstructed bladder with and dysplasia have perplasia, von Brunn's nests, been described." An adenomatous of the bladder thought to rise from ectopic prostatic tissue, has been reported. Polypoid cystitis can be found on the microscopic as well as the grossly visible level. Commonly associated with the catheter, it is as commonly recognized visually and rarely examined histologically. It is believed to be a benign lesion on a spectrum of metaplasia. This case developed as an isolated lesion strongly resembling a transitional cell papilloma and in the absence of obvious trauma. Initial papillary lesions should be harvested
1. Ekelund, P. and Johansson, S.: Polypoid cystitis: a catheter associated lesion of the human bladder. Acta Path. Microbial. Scand., 87 A: 179, 1979. 2. Friedman, N. B. and Ash, J.E.: Tumors of the urinary bladder. In: Atlas of Tumor Pathology. Washington, D. C.: Armed Forces Institute of Pathology, 1st series,sect. VIII, fasc. 31a, p. 76, 1959. 3. Mostofi, F. K.: Potentialities of bladder epithelium. J. Urol., 71: 705, 1954. 4. Johnston, S. D., Osborne, C. A. and Stevens, J.B.: Canine polypoid cystitis. J. Amer. Vet. Med. Ass., 166: 1155, 1975. 5. Ormiston, M. C., Knowles, M. A., Ogbolu, H., Newman, J., Hicks, R. M. and Milroy, E. J. G.: Urothelial abnormalities in the obstructed bladder. Brit. J. Urol., 54: 234, 1981. 6. Rubin, J., Khanna, 0. P. and Damjanov, L: Adenomatous polyp of the bladder: a rare cause of hematuria in young men. J. Urol., 126: 549, 1981.
Accepted for publication January 11, 1984. The assertions or opinions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. 963