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Radiation or chemotherapy cystitis with "pseudocarcinomatous" features
Theresa Y Chan1, Jonathan I Epstein
1Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21231, USA. tychan@jhmi.edu
The American Journal of Surgical Pathology
|June 30, 2004
Summary
Radiation or chemotherapy can cause cystitis that mimics urothelial cancer. Pathologists should recognize characteristic features like epithelial proliferation and vascular changes to distinguish it from invasive cancer.
Area of Science:
- Uropathology
- Oncology
- Medical Imaging
Background:
- Radiation and chemotherapy can induce cystitis, a bladder inflammation.
- The features of this cystitis can mimic invasive urothelial cancer, leading to diagnostic challenges.
Purpose of the Study:
- To identify and describe the pathological features of radiation or chemotherapy-induced cystitis that mimic invasive urothelial cancer.
- To aid pathologists in differentiating these benign changes from malignant neoplasms.
Main Methods:
- Retrospective review of 20 bladder biopsy cases diagnosed with cystitis mimicking invasive urothelial cancer.
- Analysis of patient history, including radiation and chemotherapy exposure.
- Detailed histopathological examination of biopsy specimens.
Main Results:
- Epithelial proliferation mimicking invasive cancer was observed in all cases.
- Characteristic findings included pseudoinvasive nests, fibrin deposition, hemorrhage, fibrosis, and vascular changes.
- Mild to moderate nuclear pleomorphism was present in all cases, with 75% showing no mitoses.
Conclusions:
- Radiation or chemotherapy cystitis presents with epithelial changes that can be mistaken for invasive urothelial carcinoma.
- Distinctive features such as hemorrhage, fibrin, and vascular alterations are key to differentiation.
- Awareness of patient history is crucial for accurate diagnosis, especially when information is limited.