Introduction
Cystitis glandularis is a benign disorder characterized by proliferative metaplasia of the urinary bladder. Another name for it is glandular metaplasia or glandular cystitis. It is characterized by chronic irritation in a small percentage of the population. In general, asymptomatic or nonspecific findings are observed; thus, they are frequently misdiagnosed. If it is macroscopic, it can be seen as a clear mass on the urinary bladder, but clinical studies do not support this macroscopic symptom. It is more prevalent in women and children than in men. This condition, if it evolves, may lead to malignant degeneration. Two forms of cystitis glandularis are typical glandularis (non-mucinous) and intestinal metaplasia (mucinous). These two disorders differ in histology, the possibility of causing adenocarcinoma, prognosis, and diagnosis. Surgical intervention is extensively needed to manage it.
What Is Cystitis Glandularis?
Cystic glandularis is a rare proliferative lesion of the urinary bladder that is a benign reactive metaplasia of the urothelium. Cystitis glandularis is an unusual proliferative disorder that can be seen in the urinary bladder.
Who Discovered Cystitis Glandularis as a Disorder?
In 1761, Morgagni was the first to describe cystitis glandularis as a disorder. And the hypothesis that cystitis glandularis is a probable cause of adenocarcinoma of the bladder was given in a study by Immergut and Cottler in 1950. But many scientists found no relevance between cystitis glandularis and malignancy. It is a very rare disorder of benign type. cystitis glanduralis has always been a topic that is captivating for many scientists. Cystitis glanduralis is closely related to cystitis cystica, which can be observed to be commonly associated with it.
Who Gets Affected by This Disorder?
Women and children are more susceptible to cystitis glandularis than men. In men, they were seen affected by cystic glandularis at the peak of the age of around 50.
What Is the Etiology of Cystitis Glandularis?
Generally, it is said that the cause of the disorder is idiopathic. It is a disorder in which unfamiliar proliferation is seen and characterized by transitional cells undergoing glandular metaplasia. Probable causes could be congenital and acquired, including bladder exstrophy, long-term catheterization, calculi, and neurogenic bladder. Histologically, chronic irritation by the tumors, calculi, or any type of infection can result in metaplasia of the urothelium. The pathogenesis of this condition is considered to be either congenital, that is, the partial origin of the bladder from the embryonic cloaca, or due to chronic irritation leading to intestinal metaplasia of the urothelium.
How Is Cystitis Glandularis Correlated With Microorganisms?
The micro-organism responsible for the correlation between upper urinary tract infection and cystitis glanduralis is Escherichia coli. Microorganisms like Pseudomonas, Proteus, Chlamydia, and Staphylococcus aureus can also be associated with it.
What Can Be the Reasons for Causing Cystitis Glandularis?
Pelvic lipomatosis, stones, obstruction, neurogenic bladder, benign prostatic hypertrophy, or chronic bladder inflammation could cause it. However, there is no evidence to associate these factors with cystitis glanduralis; they are just hypotheses.
What Are the Symptoms of Cystitis Glandularis?
The major symptoms are upper urinary tract obstruction, renal colic, and abdominal pain. Also, a few patients were observed to have nausea, vomiting, dysuria, fever, bladder irritation, hematuria, and sensation of residual urine. Under the cystoscope, the lesion is symmetrically distributed at the urinary bladder's trigone or neck. It is also associated with recurrent urinary tract infections.
How Is Cystitis Glandularis Diagnosed?
Macroscopically, it is rare, but usually, it is found microscopically. It is diagnosed incidentally in most cases. Urinary bacterial cultures can be performed, followed by cystoscopy. Also, radiological explorations, ultrasounds, computed tomography (CT) scans, and endoscopies can be done. Transurethral resection can be performed for the diagnosis of the disease. Cystitis glandularis occurs when metaplasia in a mucous-secreting epithelium and a central lining of cuboidal or columnar cells observes it.
What Are the Radiographic Features of Cystitis Glandularis?
A lobulated outline of the urinary bladder with a nodular filling defect within is seen in the intravenous pyelogram. In the ultrasound, it is observed as focal polypoidal wall thickening of the urinary bladder in the trigone region. Through computed tomography (CT), hyper vascular polypoid masses within the urinary bladder are observed and delineated in the delayed (urography) phase. It is seen as a low-signal polypoidal lesion, and the vascular stalk represents central hyperintensity enhanced on contrast administration in magnetic resonance imaging (MRI).
How Can Cystitis Glandularis Be Treated?
Removing the source of irritation or inflammation and cystectomy or partial cystectomy can be done in the case of headstrong cystitis glanduralis. The patient who underwent complete resection of the mass did not show a re-occurrence of the symptoms in a study. Surgical intervention is a must in serious cases, and it is possible to convert into adenocarcinoma, so the patients should be monitored.
What Is the Prognosis of Cystitis Glandularis?
It is an assumption that cystitis glandularis is a potentially premalignant lesion. But this is just a hypothesis, and studies are going on to prove it. The common factor between bladder carcinoma, intestinal glandularis, and typical glandularis was evaluated. The research done amongst a few patients suggested no familiar factors between adenocarcinoma and typical or intestinal glandularis. Thus, this hypothesis that cystitis glandularis is a potentially premalignant lesion was not followed. Glandular cystitis evolution is controversial and is discussed around the risk of malignant degeneration. Evolution can be stated with recurrences, and evolutionary mode can be continuous or intermittent, with intervals of variable times. Due to uncertainty over the malignant potential, the management of cystitis glandularis is still questionable. Cases of cystitis glandularis are rare, so enough studies could not be conducted.
Conclusion
A limitation of the present study was that the follow-up period needed to be longer. The progression of cystitis glanduralis to cancer may be a long-term process; therefore, a shred of concrete evidence is lacking from the present study, and a longer follow-up period is required. Currently, a therapeutic recommendation for cystitis glandularis cannot be proposed due to the lack of reported previous cases and uncertainty regarding etiopathogenesis. Therefore, a large-scale, multi-center follow-up study is required to facilitate the accurate determination of a prognosis for patients with cystitis glandularis.
