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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 3: 64 year old male had a history of radical nephrectomy for non-invasive papillary urothelial carcinoma
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Question 1 of 1
1. Question
Category: noseWeek 1: Case 3
A 64 year old male had a history of radical nephrectomy for non-invasive papillary urothelial carcinoma. The patient had also a history of bladder catheterization and now presents with multiple bladder lesions.
Correct
Answer: Inverted papilloma with carcinoma in-situ
Histology: The urothelium is of normal thickness with uniform bland cytology. There are numerous eosinophils in the urothelium as well as in the lamina propria. A dense lymphocytic infiltrate is also present in the lamina propria. No parasites are noted.
Discussion: Rarely numerous eosinophils may be seen in the bladder as part of a systemic allergic reaction. In order to diagnose allergic cystitis, there should be a history of systemic allergy such as asthma or a severely atopic individual. Usually, allergic cystitis would be accompanied by increased eosinophils in the peripheral blood. In these cases, the patients may be treated with steroids. Another setting with increased eosinophils in the bladder is with parasites. The most common situation is with Schistosomiasis seen typically in patients from Africa or with travel to this region. In these cases, the parasites are usually readily identifiable. More commonly the presence of eosinophils is merely a component of reactive subacute inflammation, such as may be seen surrounding a recent TUR site or other areas relating to injury. In the current case, it most likely arose as a response to the catheter. In cases without a specific etiology, they should be diagnosed descriptively as eosinophilic cystitis with a list of the potential etiologies with clinicopathological correlation needed.
Incorrect
Answer: Inverted papilloma with carcinoma in-situ
Histology: The urothelium is of normal thickness with uniform bland cytology. There are numerous eosinophils in the urothelium as well as in the lamina propria. A dense lymphocytic infiltrate is also present in the lamina propria. No parasites are noted.
Discussion: Rarely numerous eosinophils may be seen in the bladder as part of a systemic allergic reaction. In order to diagnose allergic cystitis, there should be a history of systemic allergy such as asthma or a severely atopic individual. Usually, allergic cystitis would be accompanied by increased eosinophils in the peripheral blood. In these cases, the patients may be treated with steroids. Another setting with increased eosinophils in the bladder is with parasites. The most common situation is with Schistosomiasis seen typically in patients from Africa or with travel to this region. In these cases, the parasites are usually readily identifiable. More commonly the presence of eosinophils is merely a component of reactive subacute inflammation, such as may be seen surrounding a recent TUR site or other areas relating to injury. In the current case, it most likely arose as a response to the catheter. In cases without a specific etiology, they should be diagnosed descriptively as eosinophilic cystitis with a list of the potential etiologies with clinicopathological correlation needed.
