Cystitis glandularis is a term denoting the transformation of the transitional epithelium of the urinary bladder into columnar, presumably due to irritation by infectious agents, stones, neoplastic disorders or other processes. The eventual formation of cysts can lead to symptoms resembling a urinary tract infection - abdominal pain, hematuria, dysuria, nocturia, increased urinary frequency, etc. Its potential to proliferate into a malignant tumor is still a topic of discussion. A biopsy is necessary to confirm the diagnosis.
Cystitis glandularis is considered to be a proliferative lesion of the bladder mucosa that develops as a result of metaplasia of the urinary bladder epithelium, transforming from transitional to simple columnar (with or without mucus production)     . Its pathogenesis is assumed to include chronic irritation and typical examples are infections of the urinary tract, calculi, obstruction, or tumors   . Because of its frequent propensity to protrude into the submucosa and the lamina propria (forming von Brunn's nests or buds that progress into mucin-secreting goblet cells, thus the term cystitis glandularis), several studies have examined the possible premalignant nature of this condition, but solid evidence are yet to be obtained   . In addition, pelvic lipomatosis is another clinical entity associated with the occurrence of this disease, presumably by contributing to long-term infection of the lower urinary tract and its obstruction . The exact prevalence rate remains largely undetermined, but isolated studies show that its presence is noted in approximately 2.4% of children who suffered from a urinary tract infection (UTI)  . Signs and symptoms like abdominal or flank pain, pelvic/perineal discomfort, increased urinary frequency and urgency, dysuria, nocturia, enuresis, hematuria, and vomiting (in rare cases) are complaints that have been reported in the literature    .
Entire Body System
All cases were identified as either typical or intestinal type CG by surgical pathology, as reviewed by two pathologists. Clinical information was obtained from the patients’ clinical charts. [doi.org]
18/38 (47%) cases reported by Jacobs et al.  In the literature, though the incidence of CGIT is reported to be less than CG usual type,  the relatively high incidence of CGIT in this and other studies  is probably due to the likelihood of pathologists [ijpmonline.org]
Soft Tissue Mass
Upon persistence of her complaints, urinary system ultrasonograms and abdominal tomograms were obtained when she was 17; these revealed a soft tissue mass extending from the posterior wall of the bladder into the bladder lumen. [thefreelibrary.com]
The diagnosis may be difficult to make without a thorough clinical and imaging investigation. Physicians must start the workup by obtaining a detailed patient history that will reveal the duration of symptoms, their onset, and determine if preexisting irritative factors exist (chronic infection, history of calculi in the urinary tract, catheterization, etc.). Some of the findings, such as perineal discomfort or abdominal pain, can be confirmed during the physical examination. To identify cystitis glandularis as the underlying cause of associated symptoms, however, imaging studies need to be employed. Cystoscopy is a useful tool to visualize the lesion, which shows a cobblestone pattern of the mucosa, or in some cases, a papillary or polypoid mass  . Because of its appearance, the provisional diagnosis of a malignant tumor is often made, thus a biopsy sample, regarded as the gold-standard of the diagnostic workup, with the subsequent pathological examination, is necessary to solidify clinical suspicion  . Computed tomography (CT) and magnetic resonance imaging (MRI) have also been described as potentially useful methods . Low signal intensity on both T1 and T2-weighted studies (with a high-intensity pattern in the center) are seen on MRI studies .
Squamous Metaplasia of the Bladder
The prevalence and significance of Brunn's nests, cystitis cystica and squamous metaplasia in normal bladders. J Urol 1979;122:317-21. [ PUBMED ] 2. Young RH, Elbe JN. Non neoplastic disorders of the urinary bladder. [ijpmonline.org]
Wiener DP, Koss LG, Sablay B, Freed SZ (1979) The prevalence and significance of Brunn's nests, cystitis cystica and squamous metaplasia in normal bladders. J Urol 122: 317-321. [clinmedjournals.org]
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- Li A, Liu S, Lu H, et al. Clinical character of cystitis glandularis accompanied with upper urinary tract obstruction. Can Urol Assoc J. 2013;7(11-12):E708-E710.