Cystitis Glandularis with Intestinal Metaplasia

Abstract

Cystitis glandularis (CG) is an unusual proliferative disorder of the urinary bladder, which is characterized by transitional cells that have undergone glandular metaplasia.  Cystitis glandularis has occasionally been proposed as a precursor of adenocarcinoma by various studies. Also, the intestinal subtype of cystitis glandularis has been described as premalignant. Here, we report a case of 37 year old female presenting with hematuria and acute retention of urine with cystoscopy revealing a pedunculated growth arising from the anterior wall of the bladder. Transurethral resection of the bladder tumour was performed and histopathology suggested cystitis glandularis with intestinal metaplasia. Immunohistochemical study was done using CDX2 and CK20 which showed nuclear and cytoplasmic positivity respectively and hence the diagnosis was confirmed. Intestinal metaplasia is a risk factor and a putative precursor of adenocarcinoma. Hence the, proper evaluation of the histological features and immunohistochemical studies of cystitis glandularis, especially intestinal type helps in correct categorization of this lesion. Due to the increased occurrence of adenocarcinoma in patients with cystitis glandularis, it is recommended to have a close follow up of the patients diagnosed with cystitis glandularis with intestinal metaplasia because it may turn malignant.