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Mast cells and nerve fibers in interstitial cystitis (IC): an algorithm for histologic diagnosis via quantitative
M A Hofmeister1, F He, T L Ratliff
1Division of Cellular and Molecular Pathology, University of Pittsburgh School of Medicine, Pennsylvania 15213-2582, USA.
Insights
A new diagnostic algorithm for interstitial cystitis (IC) uses mast cell and nerve fiber alterations in bladder tissue. This method helps diagnose IC by analyzing the detrusor to mucosa mast cell ratio and nerve fiber density.
Area of Science:
- Urology
- Pathology
- Immunology
Background:
- Interstitial cystitis (IC) is a chronic condition characterized by bladder pain and urinary urgency.
- Current diagnostic methods for IC can be invasive and lack specificity.
- Alterations in mast cells and nerve fibers are observed in bladder tissue of IC patients.
Purpose of the Study:
- To develop and validate a diagnostic algorithm for interstitial cystitis (IC).
- The algorithm is based on quantifying mast cell and nerve fiber changes in bladder tissue.
Main Methods:
- Quantitative image analysis and morphometry (QIAM) were used to calculate the detrusor to mucosa mast cell ratio (DMMCR).
- Giemsa staining was employed for mast cell quantification.
- Immunohistochemical staining for S-100 protein was performed to assess nerve fiber proliferation.
Main Results:
- Nonclassic IC (NC-IC) showed an average DMMCR of 1.19.
- Bacille Calmette-Guérin (BCG) cystitis had a DMMCR of 0.84, while normal bladder tissue had a DMMCR of 0.45.
- Increased nerve fiber presence in the detrusor was observed in IC patients compared to controls and BCG-treated patients.
Conclusions:
- A diagnostic algorithm is proposed: DMMCR > 0.75 suggests IC, DMMCR < 0.5 suggests no IC.
- For DMMCR between 0.5 and 0.75, S-100 protein staining aids in diagnosing marginal NC-IC cases.
- Findings suggest a potential neuroimmune mechanism in IC pathogenesis.
Objective:
To develop and evaluate a diagnostic algorithm based on the alteration of mast cell and nerve fiber observed in bladder tissue of patients with interstitial cystitis (IC).
Materials And Methods:
Non-IC samples from 6 control groups (N = 10, 10, 13, 2, 11, and 3, respectively) and nonclassic interstitial cystitis (NC-IC, N = 20) were stained with Giemsa stain in order to calculate the detrusor to mucosa mast cell ratio (DMMCR) using quantitative image analysis and morphometry (QIAM). Immunohistochemical staining for S-100 protein was also performed to quantify nerve fiber proliferation in the detrusor muscle of the bladder.
Results:
The average DMMCR of NC-IC was 1.19. Bacille Calmette-Guérin (BCG) cystitis was 0.84 and microscopically normal bladder tissue from patients with bladder or prostate cancer was 0.45. No case of IC that we examined had a DMMCR < 0.5. The number and percentage area of nerve fibers in the detrusor in IC were increased compared to controls and BCG (IC, 2.01%; BCG, 0.95%; control, 1.3%).
Conclusion:
A diagnostic algorithm is proposed for IC based on the findings that indicate that: 1) if the DMMCR > 0.75, then IC is present; 2) if the DMMCR < 0.5, then IC is negative; and 3) if the DMMCR is between 0.5 and 0.75, a quantitative S-100 protein staining analysis can be employed to evaluate nerve fiber proliferation to detect those marginal cases of NC-IC. The findings of the study also suggest that a neuroimmune process or mediation may be involved in the pathogenesis of IC.
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