Cystitis glandularis are small focal polypoid bladder mucosal thickenings and irregularities due to metaplasia of the urothelium (to mucin producing goblet cells) which proliferates into buds growing down into the lamina propria; this entity is closely related to cystitis cystica, with which it commonly co-exists. It is a relatively common chronic reactive inflammatory disorders that occur in the setting of chronic irritation of the bladder mucosa.
Cystitis cystica is seen in a variety of patients, who all have chronic bladder inflammation as a uniting feature. The underlying causes include:
- chronic bladder outlet obstruction
- chronic infection
- bladder calculi
Chronic irritation from infection, calculi or even tumours results in metaplasia of the urothelium, which proliferates into buds, which grow down into the connective tissue beneath the epithelium in the lamina propria. In the case of cystitis glandularis, the buds then differentiate into mucin producing goblet cells (whereas in cystitis cystica they differentiate into fluid filled cysts). In most cases, examples of both conditions can be identified histologically.
Lobulated outline of the urinary bladder with a nodular filling defect within.
Hypervascular polypoid masses within the urinary bladder.
- T1: may be seen as low signal polypoidal lesion
- T2: low signal lesion with central branching hyperintensity. Central hyperintensity enhances on contrast administration and represents vascular stalk.
Treatment and prognosis
Treatment consists of removing the source of irritation and surgical excision of the area of inflammation or cystectomy in rare severe cases. An association with adenocarcinoma of the bladder has been described, and thus these patients should be monitored.
One important differential on imaging is urothelial carcinoma. An intact muscle layer is seen in cystitis cystica and cystitis glandularis. This usually requires MRI in order to better distinguish the bladder walls layers.
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- 2. Kauzlaric D, Barmeir E, Campana A. Diagnosis of cystitis glandularis. Urol Radiol. 1988;9 (1): 50-52. doi:10.1007/BF02932630