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Radiation Cystitis

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  • Typically occurs ~3 to 6 weeks after radiation of pelvic tumors.
  • Histology:
    • Urothelium exhibits marked cytologic atypia characterized by nuclear pleomorphism, smudgy chromatin and cytoplasmic vacuolations, but with normal or maintained nuclear to cytoplasmic ratio (image A) & (image B).

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    • Background stroma also exhibits pronounced atypia (image C).
    • Blood vessels are thickened and hyalinized (image D).
    • Lamina propria with edema or fibrosis.
    • Pseudocarcinomatous epithelial hyperplasia may develop which can closely mimic carcinoma.
  • Awareness of the history of prior pelvic radiation is important because of the morphologic mimicry to urothelial carcinoma.