Eosinophilic cystitis mimicking bladder tumor: A case report.

Eosinophilic cystitis (EC) is a rare inflammatory condition characterized by eosinophilic infiltration into the bladder wall. It often presents symptoms common to urological issues such as urinary tract infections, hematuria, bladder stones, or bladder neoplasms. Here, we describe a case of a 44-year-old male veteran with a history of multiple tuberculosis episodes who presented to the Emergency Department with dysuria, suprapubic pain, and gross hematuria. Initial imaging and cystoscopy concerned bladder neoplasia; however, subsequent pathological evaluation showed EC. This case underscores the importance of considering EC in the differential diagnosis of bladder tumors, especially when imaging describes bladder wall thickening in a patient without risk factors for bladder malignancy.

The clinical and imaging features of eosinophilic cystitis in children: a case series study.

BACKGROUND: Eosinophilic cystitis (EC) is rare in children and remains poorly understood. Our aim was to analyse the clinical and imaging features of eosinophilic cystitis in children. METHODS: A retrospective review of histologically confirmed eosinophilic cystitis between January 2008 and December 2022 was performed, including patient age, sex, symptoms, laboratory examination, radiology, treatment and outcome. RESULTS: Twelve children (two girls, 10 boys; age range: 3-12 years, mean age: 7.2 years) were included in the study. Urinary irritation symptoms (10/12), haematuria (5/12) and hypogastralgia (3/12) were the most common symptoms. Five patients had a history of allergies, six patients had elevated serum IgE, nine patients had elevated peripheral eosinophils and six patients had positive microscopic haematuria. Radiology revealed diffuse homogeneous or inhomogeneous thickening in seven patients, localised thickening in three patients, and solitary tumour-like lesions in the other two patients. Preservation of the mucosal line and bladder wall layering were observed in eleven patients, and perivesical exudation and small vessel dilatation were observed in ten patients. All four patients with delayed scans showed obvious delayed enhancement. One patient showed low signal intensity on T2-W imaging. All patients received antihistamine, antibiotic and/or corticosteroid therapy and two tumour-like patients underwent transurethral resection. Nine patients achieved complete response and three patients achieved partial response. CONCLUSION: The clinical and imaging manifestations of EC in children have relative characteristics; when urologist and radiologist confronted with similar cases, EC should be considered. The final diagnosis depends on pathological biopsy.

Eosinophilic cystitis: a case report of a pseudotumoral lesion.

Eosinophilic cystitis is a rare inflammatory disorder of the bladder, characterized by eosinophilic infiltration of the bladder wall, fibrosis of the mucosa, and muscle necrosis. Ultrasonography, when performed, shows a pseudotumoral mass that can be mistaken for malignancy. We report a case of a woman referred to our department in which an ultrasound showed a bladder mass and the biopsy demonstrated the presence of eosinophilic cystitis. The patient was treated with medical treatment and the outcome was favorable with the disappearance of symptoms and no recurrence at controls. We carry a literature review of cystitis eosinophilic, the ultrasound appearance, and therapeutic modalities.

A case of eosinophilic cystitis coexisting of superficial bladder cancer, mimicking muscle-invasive cancer.

Introduction: Here, we present a rare case of eosinophilic cystitis coexisting with bladder cancer, which appeared to be an invasive carcinoma on imaging. Case presentation: A 46-year-old man presented with urinary urgency. Computed tomography revealed an irregular and thickly enhanced bladder wall, which seemed to be invasive bladder cancer. Cystoscopy revealed a raspberry-like mass lesion on the entire bladder circumference. Pathological diagnosis after transurethral resection was pathological T1 urothelial carcinoma. After a thorough discussion of treatment options, the patient elected to receive intravesical Bacillus Calmette-Guérin. Three months after Bacillus Calmette-Guérin administration, no residual disease was confirmed by transurethral biopsy, and no recurrence was observed over 2 years. As peripheral eosinophilia and submucosa eosinophil infiltration were identified, the patient was diagnosed with coexisting eosinophilic cystitis and urothelial carcinoma. Conclusion: Clinicians should consider the possibility of eosinophilic cystitis with superficial bladder cancer coexistence in patients who present with an irregular and thick bladder wall.

Correlation of urinary catheterization with histologic grading of eosinophilic cystitis: a single institutional review of 27 cases.

Eosinophilic cystitis (EC) is an uncommon diagnosis, mimicking urothelial carcinoma. Multiple etiologies including iatrogenic, infectious, and neoplastic have been suggested, effecting both adults and pediatric population. A retrospective clinicopathologic review of patients with EC in our institution between 2003 and 2021 was conducted. Age, gender, presenting symptoms, cystoscopic findings, and history of urinary bladder instrumentation were recorded. Histologically, urothelial and stromal changes were noted, and mucosal eosinophilic infiltration was graded as mild (scattered eosinophils in the lamina propria), moderate (visible small clusters of eosinophils without brisk reactive changes), or severe (dense eosinophilic infiltrate with ulcer formation and/or muscularis propria infiltration). Twenty-seven patients (male to female ratio = 18/9, median age 58 [12-85 years]), of whom two were in the pediatric age group were identified. Leading presenting symptoms were hematuria (9/27, 33%), neurogenic bladder (8/27, 30%), and lower urinary tract symptoms (5/27, 18%). Four of 27 (15%) patients had history of urothelial carcinoma of urinary bladder. Cystoscopy commonly revealed erythematous mucosa (21/27, 78%) and/or urinary bladder mass (6/27, 22%). Seventeen of 27 (63%) of patients had history of long-term/frequent catheterization. Mild, moderate, and severe eosinophilic infiltrates were seen in 4/27 (15%), 9/27 (33%), and 14/27 (52%) of cases. Proliferative cystitis (19/27, 70%) and granulation tissue (15/27, 56%) were additional common findings. All cases of long-term/frequent instrumentation cases had moderate or severe eosinophilic infiltrate. EC should be in the differential diagnosis; particularly in patients with long term/frequent catheterization.

A conservative treatment for eosinophilic cystitis.

Introduction: Eosinophilic cystitis is a rare condition which causes common symptoms and may mimic other conditions. Eosinophilic cystitis has several causes such as hypereosinophilic syndrome, inflammatory diseases, neoplasia, parasites or fungal infection, IgE-related diseases, Drug Reaction and Eosinophilia and Systemic Symptoms (DRESS) syndrome, or Churg-Strauss syndrome. Therefore, differential diagnosis is difficult. Case presentation: We report the case of a middle-aged man affected by eosinophilic cystitis with persistent hematuria and other peculiar symptoms that may be brought back to hypereosinophilic crisis. Conclusion: Conservative approach is preferred, avoiding radical cystectomy rather than corticosteroid, antihistaminic and second line therapy. Hyperbaric therapy is an innovative approach for severe relapsing gross hematuria without specific literature and should be studied for further indications.

Primary hydatid cyst of the urinary bladder with associated eosinophilic cystitis: Report of a unique case.

Hydatid cyst of Echinococcus granulosus usually develops in liver and lungs of the affected individual and is considered a common health problem in endemic regions. Although, the cyst can be found in less common locations, such as brain, heart, and bones, the urinary bladder is extremely rare that may mimic malignancy radiologically and creates a diagnostic dilemma for clinicians and radiologists. Here we present a unique case of hydatid cyst in the urinary bladder with associated eosinophilic cystitis.

Eosinophilic cystitis mimicking hemorrhagic cystitis in relapsed follicular lymphoma.

Eosinophilic cystitis (EC) is a rare and non-infectious inflammatory disorder characterized by transmural infiltration of eosinophils in the bladder wall. The diagnosis of EC is made only by the pathophysiological findings. Because the urinary symptoms of EC are quite similar to other urinary tract disorders including hemorrhagic cystitis (HC), it can be misdiagnosed or left undiagnosed. A 49-year-old woman with relapsed and refractory follicular lymphoma presented with sudden-onset gross hematuria after the chemo-immunotherapy. The patient was initially treated as HC with continuous bladder irrigation, resulting in recurrent and refractory hematuria. Corticosteroid dramatically resolved hematuria after the bladder biopsy revealed EC. It is important to suspect EC and perform bladder biopsy in patients with recurrent episodes of hematuria or refractory to conservative treatment for HC.

Eosinophilic cystitis complicated with cystitis glandularis: a case report.

BACKGROUND: Eosinophilic cystitis (EC) is a rare inflammatory disease characterized by the gathering and infiltration of numerous eosinophilia (EOS) in the bladder wall. Because of Few cases of EC have been reported globally, the epidemiology of EC is not well known. We report herein the details of one very scarce case of large tumor-like eosinophilic cystitis complicated with cystitis glandularis (CG) diagnosed by biopsy. CASE PRESENTATION: A 45-year-old Chinese man was referred to our hospital for the treatment of right lumbago and odynuria. Ultrasound examination indicated the low echo on the right portion wall and the neck of the bladder. Computed tomography showed a remarkable enhancing large mass that measured 5.0 cm × 2.3 cm located on the right portion of the bladder with undefined margin. For further treatment, diagnostic transurethral resection of the bladder was performed, the postoperative histopathological diagnosis was EC complicated with CG. After transurethral resection, antibiotics, glucocorticoids, and antihistamines were treated. The patient recovered uneventfully and was discharged on postoperative day 8 without evidence of recurrence followed-up for 6 months. CONCLUSION: Large tumor-like eosinophilic cystitis complicated with cystitis glandularis is rare, malignant tumors need to be ruled out. We deem that prompt biopsy led to the exact diagnosis, appropriate treatment led to better prognosis.

A rare presentation of eosinophilic cystitis in paediatric urology.

Eosinophilic cystitis (EC) is a rare inflammatory condition of the urinary bladder. It is extremely rare in childhood and may present with haematuria, lower abdominal mass or recurrent urinary tract infections. We present the case of a 5-year-old girl with recurrent, painless visible haematuria. Ultrasound showed a bladder mass and left hydronephrosis. Cystoscopy and bladder biopsy confirmed the diagnosis. The patient was successfully managed with oral treatment. In the case of EC, cystoscopy and bladder biopsy is key for diagnosis. Conservative management of unilateral hydronephrosis in EC is appropriate and we advise oral corticosteroids in its treatment.

Refractory eosinophilic cystitis controlled with low-dose cyclosporine therapy: A case report.

Eosinophilic cystitis (EC) is a rare disease of the bladder with no clear inciting etiology, pathogenesis, or standard treatment. We present the case of a 78-year-old woman with a three-year history of refractory EC with symptoms characterized by urinary frequency, gross hematuria, dysuria, and suprapubic pain. Despite treatment with a silver nitrate instillation, antibiotics, alpha-1 blockers, antihistamines, antimuscarinics, beta-3 agonists, and intravesical steroid injections, her symptoms persisted. She was then trialed on systemic therapies including prednisone, montelukast, and cyclosporine. Upon follow-up after initiation of therapy with low-dose cyclosporine she had an excellent response, both symptomatically and anatomically via cystoscopy.

A rare case of eosinophilic cystitis involving the inside and outside of the urinary bladder associated with an infected urachal cyst.

BACKGROUND: Eosinophilic cystitis is a rare inflammatory disease of the bladder characterized by eosinophilic infiltration of the bladder wall. Most Eosinophilic cystitis cases present with mucosal lesions of the urinary bladder. We present a very rare case of large mass-forming eosinophilic cystitis, involving the inside and outside of the bladder associated with an infected urachal cyst. CASE PRESENTATION: A 59-year-old man presented with gross hematuria, fever, dysuria, and suprapubic pain. Computed tomography showed a heterogeneously enhancing mass that measured 7.6 cm × 4 cm located on the anterosuperior portion of the bladder with an internal fluid collection. Cystoscopy revealed a raspberry-like mass lesion on the bladder dome. Transurethral resection of the bladder was initially performed. The mass lesion protruding from inside the bladder was removed, and pus-like fluid was drained. The pathologic diagnosis was eosinophilic cystitis. Follow-up computed tomography showed a remnant mass outside the bladder and urachal cyst. To eliminate the remnant lesion, robot-assisted partial cystectomy was performed. The patient showed no evidence of recurrent disease on follow-up cystoscopy and computed tomography for up to 2 years. CONCLUSIONS: Clinicians should consider the possibility of eosinophilic cystitis in patients who present with hematuria, fever, and suprapubic pain and have both intravesical and extravesical masses.

Clinicopathological characteristics and outcomes of eosinophilic cystitis: A retrospective study.

BACKGROUND: Eosinophilic cystitis (EC) is a rare inflammatory urinary bladder disorder whose etiology, pathogenesis, and treatment are unknown. The work aims to evaluate the clinical manifestations, cystoscopic characteristics, pathological features, treatment, and clinical outcome of EC patients. MATERIALS AND METHODS: The clinical records and histopathology material of 22 patients diagnosed as EC during ten years were reviewed and analyzed for patient's age, sex, clinical data, cystoscopic features, biopsy procedures, treatment plan, follow-up, and prognosis. Frequencies, normality tests, descriptive statistics, and correlations were run. RESULTS: The mean age of patients was 46.5 + 17 years, 12 females and 10 males. Regarding the patient's complaints, dysuria was the most frequent main symptom, followed by hematuria. On cystoscopic examination, bladder mass was seen in 54.5% of patients. Six patients (27.3%) were associated with different allergic diseases; however peripheral eosinophilia was shown in two patients (9.1%). All cases revealed predominance of eosinophilic infiltration on microscopic examination. The most commonly used medications were corticosteroids for 72.7% of patients with tapering dose giving a significant improvement with a recorded recurrence in one patient after 12 months from the first lesion. CONCLUSIONS: No specific clinical presentation for EC patients and histopathology is the standard diagnostic tool. Medical treatment including corticosteroids was the first line with good prognosis, although recurrence remains a possibility which emphasizes the importance of patients' follow-up.

Eosinophilic Cystitis Presenting as Possible Pediatric Rhabdomyosarcoma in Conventional Imaging Including 18F-FDG-PET/CT/MRI-A Rare Case.

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed and hence, lead to the challenge in distinguishing them by cystoscopy and several image modalities. We present a case in which cross-sectional imaging modalities including fluorine-18-fluro-2-deoxy-D-glucose (18F-FDG)-positron emission tomography (PET) / computed tomography (CT) / magnetic resonance imaging (MRI) (18F-FDG-PET/CT/MRI (The imaging modality 18F-FDG-PET/CT/MRI referring to two continuous scans scanned on the same 18F-FDG-tracer dose for both the whole-body 18F-FDG-PET/CT and the regional 18F-FDG-PET/MRI of the pelvis.)) raised suspicion of RMS. Hence, the final diagnosis of EC was established by repeated histopathology. It is important to have EC in mind when seeking differential diagnosis of malignant diseases like RMS in order to provide the correct treatment for the patient and highly homogenously increased 18F-FDG-uptake should raise the suspicion of EC as a differential diagnosis. Furthermore, 18F-FDG-uptake rate is suggested as a future potential biomarker for monitoring of therapeutic response in eosinophilic inflammatory diseases, thus more research on this topic is needed.