Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

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Ureteritis Cystica:
Radiologic-pathologic
Correlation

Submitted by jdogra (not verified)

on Mon, 06/08/2009 - 07:23

● GU Radiology

Images

Figure 1

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Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

Figure 2 A

Figure 2B

Figure 3
Clinical History:

A 62-year-old female was found to

have recurrent urinary tract
infections (UTI) while being
evaluated for hip replacement

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Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

surgery.

Findings:

Figure 1 A 62-year-old female with

ureteritis cystica of bilateral
ureters. Retrograde pyleogram
shows multiple smooth well
rounded filling defects with sharp
borders that protrude into the
lumen of the ureter. Figure 2 A 62-
year-old female with ureteritis Case Spotlight
cystica of bilateral ureters.
Intraoperative ureterocystoscopy Case : Ureteritis Cystica:
revealed multiple superficial cystic Radiologic-pathologic
lesions lining the inner wall of both Correlation
the ureters (A) and the urinary
bladder (B) Figure 3 Microscopic
photograph of ureteral biopsy
showing a cystic structure with a
thin epithelial lining. The lining
epithelium consists of benign
urothelium with intact umbrella
cells. (Hematoxylin and eosin)

Diagnosis:
*Jennifer G Rothschild,
Ureteritis Cystica MD, MPH, **Guan Wu,
MD, PhD,***Shweta
Bhatt,MD

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Introduction Ureteritis cystica (UC)
is a rare and benign entity topics
characterized by inflammatory
pathology. The entity, first reported
by Morgagni in 1761 [1], is a
proliferative condition
characterized by multiple cysts and
filling defects in the urothelium [2].
UC may be associated with chronic

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Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

● Cardiothoracic urothelial irritation. Some studies ● Resident call

● GI Radiology have demonstrated causes such as issues
● GU Radiology nephrolithiasis [3] and urinary tract ● CDC Responds to
infections [4], and it has been
● Interventional Swine Flu
found in one patient following
Radiology instillation of formalin for Outbreak Among
● Mammography treatment of cyclophosphamide Humans
● Musculoskeletal induced hemorrhagic cystitis [5].
Radiology Usually there are no symptoms more
● Neuroradiology attributable to UC [2], therefore it
● Nuclear and PET is most frequently detected Conference
Imaging incidentally and the diagnosis is Calendar
usually made during uretersoscopy
● Pediatrics
or radiographically.
● Radiologic Physics Radiographically, a differential «
● Ultrasound diagnosis of multiple transitional
cell tumors, ureteral June
pseudodiverticula, non-opaque
Terms and calculi, polyps, papillary tumor, »
Conditions vascular impressions, tuberculosis,
iatrogenic gas bubbles, gas forming S M T W T F S
microorganisms, and submucosal 1 2 3 4 5 6
● Code of Conduct
hemorrhage can be considered with
● Privacy Policy appropriate clinical correlation. 7 8 9 10 11 12 13
Our patient was a 62-year-old
female who was found to have
Navigation recurrent urinary tract infections
14 15 16 17 18 19 20
(UTI) while being evaluated for hip
● Recent posts replacement surgery. Contrast 21 22 23 24 25 26 27
enhanced computed tomography
(CT) of her abdomen and pelvis 28 29 30
User login demonstrated bilateral 2 - 3 mm
renal calculi. Since the stones were
quite small, the patient underwent Recent comments
ureteroscopy for planned treatment
of her calculi. A retrograde
pyelogram was performed that
showed multiple filling defects
[Figure 1]. Subsequent
ureteroscopic examination showed
multiple cystic lesions dispersed
throughout the bladder as well as
along both ureters and renal

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Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

Username: * pelvises [Figure 2]. A biopsy of the ● Excellent case

cystic lesion was obtained and it 1 week 4 days ago
proved to be UC. [Figure 3]. ● Informative case
Password: * Radiologic Features At intravenous
2 weeks 3 hours
urography or retrograde
ago
pyleography, the most common
Log in ● Trushar: Its an
radiologic appearance of UC is that
excellent
of numerous small, true contour
● Create new account defects of near uniform size, 2 - 3 2 weeks 4 days
● Request new mm in diameter in the ureter and up ago
to 2 cm in the renal pelvis. The ● MR versus ERCP
password
majority of cysts appear 2 weeks 4 days
hemispherical in shape as opposed ago
Syndicate to air bubbles that appear round ● IPMT of pancreas
content [Figure 1]. Pathologic Features UC 2 weeks 5 days
manifests as cystic areas of ago
glandular metaplasia associated ● Excellent case.
with chronic urothelial Thank you
inflammation. The more commonly 2 weeks 5 days
seen presentation is in the bladder, ago
where they are called cystitis ● Great case
cystica, where the nodules are 3 weeks 1 day ago
usually located on the trigone and ● Excellent case
bladder neck region. Within islands 3 weeks 3 days
of benign-appearing urothelium are ago
Von Brunn's nests located in the ● Re:
lamina propria. Cystitis cystica
5 weeks 12 hours
occurs when the urothelium in the
ago
center of the von Brunn's nests has
undergone eosinophilic
liquefaction [6]. Microscopic
examination of our patient’s
ureteral biopsy showed an intact
cystic structure lined by benign
urothelium with intact umbrella
cells, most consistent with cystitis
cystica. No goblet cells, dysplasia,
or malignancy was seen [Figure 3].
In conclusion, ureteral cystitis,
although an incidental diagnosis,
should be considered in the
differential diagnosis in the
presence of small filling defects

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Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

with a bead-like appearance along

the urothelium of the renal pelvis,
ureters, and bladder.

References / Suggested Reading:

1.Morgagni, JB: De sedibus et

causis morborum per anatomen
indagatis libri quinque. William
Cooke Translation, London, 1822,
ii, 316, 411. 2.Kilic S, Sargin SY,
Gunes A, Ipek D, Baydinc C,
Altinok MT: A rare condition: the
ureteritis cystica. A report of two
cases and review of literature.
Inonu Universitesi Tip Fakultesi
Dergisi 2003;10:87-89. 3.Ozdamar
AS, Ozkurkcugil C, Gultekin Y,
Gokalp A: Should we get routine
urothelial biopsies in every stone
surgery? Int Urol Nephrol 1997;29
(4):415-20. 4.Petersen UE, Kvist E,
Friis M, Krogh J: Ureteritis cystica.
Scan J Urol Nephol 1991;25(1):1-
4. 5.Mahboubi S, Duckett JN,
Spackman TJ: Ureteritis cystica
after treatment of
cyclophosphamide-induced
hemorrhagic cystitis. Urology
1976;7:521. 6.Edwards PD, Hurm
RA, Jaeschke WH: Conversion of
cystitis glandularis to
adenocarcinoma. Journal of
Urology 1972;108:56.

Author

*Jennifer G Rothschild, MD, MPH,

**Guan Wu, MD, PhD,***Shweta
Bhatt,MD

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Ureteritis Cystica: Radiologic-pathologic Correlation | Imaging Science Today

* Resident Urology, ** Assistant

professor Urology, *** Assist
professor Radiology

Deprt of Urology and Radiology,

University of Rochester NY

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