Original article
The importance of re-evaluation in patients with cystitis glandularis associated with pelvic lipomatosis: A case report

https://doi.org/10.1016/j.urolonc.2004.04.034Get rights and content

Abstract

Pelvic lipomatosis is a rare, proliferative disease involving an overgrowth of normal fat in the pelvic retroperitoneal space. Cystitis glandularis, cystitis cystica, or cystitis follicularis can be observed in 75% of patients with pelvic lipomatosis. We describe a 58-yr-old man with pelvic lipomatosis in whom adenocarcinoma of the bladder was diagnosed in the second transurethral resection of the bladder 1 month after the first operation. This proliferative disease can cause obstruction of the bladder drainage leading to a proliferative cystitis because of an altered environment rich in protein fluid. Because the association of this proliferative disease with adenocarcinoma of the bladder is frequent, we recommend close follow-up of these patients to detect the associated adenocarcinoma of the bladder.

Introduction

A 58-yr-old man with obstructive lower urinary tract symptoms revealed intermediate obstructive pattern on uroflowmetry (maximum flow rate: 12 cc/sec) with 200 cc of residual urine volume. Renal function tests were elevated with renal scintigraphy revealing minimal excretory function in both kidneys. Cystography showed a pear-shaped bladder with trabeculation and multiple diverticulas (Fig. 1A). Noncontrast computed tomography (CT) of the abdomen detected bilateral Grade 4 hydroureteronephrosis with pelvic lipomatosis (Fig. 1B). Random and multiple biopsies of the bladder together with resection of the prostate were performed and pathologic examinations of the bladder revealed cystitis glandularis (Fig. 2A). Because of probable association of adenocarcinoma in patients with pelvic lipomatosis and cystitis glandularis, the patient underwent second transurethral resection of the bladder one month after the first operation. Permanent pathology specimen showed well-differentiated adenocarcinoma of the bladder. The patient underwent radical cystoprostatectomy and ureteroileal cutaneous urinary diversion was performed with some difficulty owing to the obliteration of normal tissue planes by masses of adipose tissue.

Macroscopically, the specimen was encased by abundant fat tissue (Fig. 1C). Bladder capacity was very small with tan-white in color. There was no prominent macroscopic tumoral development.

Histological examination of the bladder showed a small well-differentiated adenocarcinoma focus in the trigone, in addition to broad areas of cystitis glandularis and cystitis cystica. Predominantly, intestinal type of glands with mucinous tall columnar epithelium with pyknotic, basally oriented nuclei was seen in the glands of cystitis glandularis (Fig. 2A). The glands were lined with normal appearing mucinous epithelium but some of the glands were composed of mucinous glands that exhibited varying degrees of atypia in focal adenocarcinoma area. Lakes of mucin were present on the surface and within the cystitis glandularis and adenocarcinoma (Fig. 2B and C). Fat cells with no evidence of atypia extended between bladder muscle bundles and they reach submucosa in one area that is concordant with pelvic lipomatosis. After 18 months of follow-up, the patient had no evidence of disease on physical examination, chest X-ray and CT of the abdomen.

Section snippets

Discussion

Pelvic lipomatosis is a rare, proliferative disease involving the mature fat of the pelvic retroperitoneal space. Pelvic lipomatosis usually causes progressive uraemia in 40% of the patients at a mean of 5 yr after diagnosis by obstructing the ureters and this phenomenon might be accepted as an indication for performing radical cystoprostatectomy and urinary diversion from a nephrologic point of view [1], [2]. Cystitis glandularis, cystitis cystica, or cystitis follicularis can be observed in

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