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Granulomatous Cystitis

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Bacillus Calmette-Guérin (BCG)-related granuloma

  • Multiple granulomas with or without caseation.
  • Bacteria (Mycobacterium bovis) may be demonstrable by acid-fast stains.

Post-transurethral resection granuloma (Post surgical necrobiotic granuloma)

  • Characterized by central fibrinoid necrosis surrounded by palisaded histiocytes (image A), (image B), (image C), & (image D).
  • Morphologically resemble rheumatoid nodule.
  • Granulomas may be long or serpinginous.
  • Surrounding inflammation of lymphocytes and plasma cells, and eosinophils in early lesions.

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Tuberculous cystitis

  • Often caused by Mycobacterium tuberculosis and may follow renal tuberculosis.
  • Early lesion often occurs at the ureteral orifice as mixed acute and chronic inflammation with non-caseating granulomas.
  • Larger granulomas may have central caseation, which is surrounded by histiocytes and with multinucleated giant cells (Langhans type).
  • Acid-fast staining confirms the presence of tuberculosis bacteria.
  • May cause obstruction of ureteral outlet.