Abstract
The cystitis glandularis is a rare and benign tumor, usually asymptomatic and is favored by chronic irritation. It is sometimes associated with a pelvic lipomatosis. Its transformation into adenocarcinoma is exceptional and occurs in cases of persistent contributing factor. Clinically, the hematuria is the dominating symptom with a pollakiuria. The treatment is various, in function of the tumoral volume and the importance of the symptomatology. The tumoral resection and the histological examination are fundamental for the diagnosis. we report 4 cases of cystitis glandularis treated in our service.
Introduction
The cystitis glandularis was described for the first time in 1761 by Morgani, it is a rare and benign tumor of the bladder, developed from the islets of Von Brunn (epithelial clusters included in the mucosal lamina propria). His clinical impact is less than 1%. It mainly affects men, with peak incidence in the age of 50 years. The lesion is usually asymptomatic and discovered in a prolonged inflammatory context. We report 4 cases of cystitis glandularis, we analyze the epidemiological, clinical, biological, pathological and therapeutic of this affection.
Case report
In the last 5 years we treated four patients with cystitis glandularis. They were all male and aged 28, 45, 47 and 50 years. The clinical symptomatology was dominated by hematuria and pollakiuria. The ultrasound showed the presence of an intravesical tissular formation in all patients, with hydronephrosis in 2 cases. A scanner performed confirms the presence of a bladder tumor. A TURB was performed, histological examination showed glandular metaplasia of bladder. One patient had a cystectomy (very important tumor), the other three have benefited, after the total resection, from an endoscopic surveillance with a good outcome with a 4-years follow.
Discussion
Several theories attempt to explain this glandular metaplasia;
One of them is the metaplasia theorie: glandular cystitis is the answer to a chronic irritation (lithiasis, urinary stasis, urinary tract infection, tumors, obstructions). When the lesions are symptomatic, two major modes of presentation are described: the first one where irritative symptoms predominate (1/3 of cases). The second one where a macroscopic hematuria predominates(2/3 of cases). The conventional radiology usually shows a trigonal mass in the bladder. The Pelvic CT scan and MRI show, in addition to the trigonal tumor, a thickening of the vesical base associate to a pelvic lipomatosis. The cystoscopy show the tumor and the pathological examination provides diagnostic certainty.The association or the transformation to a bladder adenocarcinoma is possible but rare, it is a result to a long time exposition to many unfavorable factors.The treatment of causative factor, when it is identified, is fundamental: using long-term antibiotics for infections, vesical lithotripsy for lithiasis.A surgical procedure can be used, as a total or partiel cystectomy or reimplantation of the uretera, if it's necessary.
Conclusion
We note that the cystitis glandularis is a rare affection with local malignity, and usually asymptomatic. The research and treatment of irritative cause is essential. Endoscopic resection is, in general, sufficient to control it. If the tumor is important and recurrent, sometimes we have to practice a surgical act because of its functional impact and the accompanying metaplasia.
References
1. ANDERSEN J., HANSEN B. The incidence of cell nests, cystitis cystica and cystitis glandularis in the lower urinary tract revealed by autopsies. J. Urol., 1972, 108, 421-424.
2. BELL T.E., WENDEL R.C. Cystitis glandularis: Benign or malignant? J. Urol., 1968, 100, 462-465.
3. CABANNE F., PAGES A., BILLERET C., OPPERMAN A., CARBILLET J.P. Métaplasie glandulaire de la muqueuse urothéliale. Pathologie génitale masculine, Ed. Masson, 1993, 300-301.
4. DANN R., ARGER P., ENTERLINE T. Benign proliferation process present ing as mass lesions in the urinary blad der. Am. J . Roentgenol., 1972, 116, 822-829.
5. DAVIES G., CASTRO J.E. Cystitis glandularis. Urology, 1977, 10, 128-129.
6. DAVIS E., GOLDSTEIN A., MORROW J. Unusual bladder mucosal metaplasia in a case of chronic prostatitis and cystitis. J. Urol., 1974, 111, 767-769.
7. EDWARDS P., HURM R., JAESCHKE W. Conversion of cystitis glandularis to adenocarcinoma. J. Urol., 1972, 108, 568-570.
8. FEIN R., WINTON L., NEEDEL M. Bladder calculi enveloped by extensive cystitis glandularis : case report. J. Urol., 1983, 130, 558- 559.
9. GORDON N., SINCLAIR R., SNOW R. Pelvic lipomatis with cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder : first reported case. Aust. N-Z. J. Surg., 1990, 60, 229-232.
10. HEINS C., DE KOCK M., VELDEN D. Pelvic lipomatis associated with cystitis glandularis and adenocarcinoma of the bladder. J. Urol., 1991, 145, 364-366.
11. HOLDER P., PLAIL R., WITHEROW R. Cystitis glandularis-reversal with intravesical steroid therapy. Br. J. Urol., 1990, 65, 547-548.
Source(s) of Funding
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Competing Interests
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