CASE PRESENTATION

CASE PRESENTATION2010-03-26R3 1CASE10041497 M/44C.C: prostate area mass like lesion Urinary frequency for 3 years

multiple bulous lesion orifice blulous lesion

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3PathologyDIAGNOSIS: Transurethral resection of urinary bladder #1. bladder tissue #2. prostate tissue #3. right orifice follicle 1. Cystitis cystica & cystitis glandularis, typical type No evidence of malignancy Chronic inflammation

Cystitis cystica and cystitis glandularis mimicking bladder tumorMultiple and irregular masses in bladder base, from trigone to neck cystic portions (+) extended down to mid prostate urethra TCC, less likely R/O cystitis cystica or bulbous cystitis R/O unusual bladder tumor12mm bladder diverticulum at rt posterior wallDiffuse wall thickening of seminal vesicle and decreased ppl. zone signal in prostate chronic prostatitis >Small midline cyst

5Cystitis cystica & cystitis glandularisBenign proliferative dzs of bldderBrunn's nest (80% in normal bladder) : Solid buds of urothelium in lamina propria

Cystitis cystica: cystic degeneration Cystitis glandularis: intestinal metaplasia w/ mucin producing columnar gl. Ch. reactive inflammatory disorders in setting of ch. irritation

Transitional cell small round glandular nest into the mucosa layer or often into the deep musclelayer formation of small cluster => Brunn's nest

Metaplasia of the urothelium is incited byirritants such as infection, calculi, outlet obstruction,or even tumor, , , C.C & C.G : any age, and there is reported prevalenceof 2.4% in children with urinary tract infections

6CystoscopyCobblestone pattern of mucosaCystitis glandularis : papillary or polypoid massBladder neck and trigone

Imaging findingMasses formation: vary in number and sizeUrography: filling defectCT: hypervascular polypoid massMR: T1WI- low SI T2WI- predominantly low SI with central branching high SI pattern

Cystitis cystica & cystitis glandularisThe hyperintensearea showed the most contrast enhancement andcorresponded to the vascular stalk

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Figure 17. Cystitis cystica and cystitis glandularis.Oblique view of the bladder obtained during intravenousurography shows a lobulated contour of the bladder, with a nodular filling defect (arrow).

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Fig. 1. Computed tomography reveals a intraluminal mass of theurinary bladder (arrow). Cystoscopic examination shows a polypoidmass with papillary surface projections (inset, arrow).(cystitisglandularis), (cystitiscystica

9Cystitis cystica & cystitis glandularis mimicking bladder tumorDifferential diagnosis tipYoung patient : suspicion of nonneoplastic dzs Muscle layer : should be intact - Intact low SI muscle layer of bladder on T2WI

But biopsy necessary for definitive Dx.

In young patients, their age should raise the suspicion that the lesion might be nonneoplastic,but biopsy is necessary for a definitive diagnosis.T2

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TCC Cystitis cystica 11REFERENCEInflammatory and Nonneoplastic Bladder Masses: Radiologic-Pathologic Correlation RadioGraphics 2006; 26:18471868 Brunn Nests: 1 2005;52:409-412