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Pathology for Urologists

Interstitial Cystitis

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  • Chronic inflammatory process of the bladder of unknown etiology with protracted exacerbations.
  • Much more common in women (90%) between 30's to 50's.
  • Presents with constellation of symptoms including urinary frequency, urgency, suprapubic pressure, and bladder or pelvic pains.
  • Clinical diagnosis of exclusion: must have negative culture studies, no inciting irritating agents to bladder and without bladder neoplasia.
  • Cystoscopy:
    • Reddened mucosa with ulcer containing blood vessels radiating towards a central scar
      (Hunner ulcer).
    • In non-ulcerative form, exhibits petechia and submucosal hemorrhages (glomerulations) or linear cracks after bladder distention.
  • Histology: No pathognomonic histologic features; role of pathologists is to exclude neoplasms and other known causes of cystitis.
    • Ulceration with inflammatory infiltrates composed mostly of neutrophils and granulation tissue
      (image A).
    • Perineural lymphocytic infiltration (perineuritis) common.
    • In non-ulcerative form, exhibits mucosal hemorrhages and epithelial ruptures.
    • May see increased mast cell infiltrates that can be highlighted by toluidine blue, however, is not a specific feature (image B, arrows).


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