Intravesical thiotepa-induced eosinophilic cystitis

doi:10.1016/S0090-4295(99)80312-4

Urology

Volume 46, Issue 5, November 1995, Pages 729-731

https://doi.org/10.1016/S0090-4295(99)80312-4 Get rights and content

Abstract

Eosinophilic cystitis is a rare form of an allergic cystitis. Factors such as food allergens, parasites, and drugs have been implicated in the genesis of eosinophilic cystitis. Associated risk factors include bronchial asthma, atopic diseases, and environmental allergens. Intravesical mitomycin is a reported causative agent. We report the first case of eosinophilic cystitis that developed after intravesical instillation of thiotepa for treatment of superficial bladder cancer.

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Cited by (22)

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2018, Seminars in Diagnostic Pathology
Citation Excerpt :
It is thought to act as surface abrasive to destroy the tips of papillary fronds, resulting in stubby papillae lined by neoplastic cells or fully denuded papillae. Urothelial denudation makes recurrences difficult to detect cystoscopically and document histologically but urothelial dysplasia and carcinoma in situ have been found in von Brunn's nests in case of residual disease.12–16 A range of other intravesical chemotherapeutic agents remain useful in selected patients.
Intravesical immunotherapy, chemotherapy, and neoadjuvant systemic chemotherapy are among the most frequent therapeutic procedures to treat malignancies of the urinary bladder. These treatment modalities produce reactive morphologic changes in the urothelium that can mimic urothelial carcinoma in situ, urothelial dysplasia or true invasive urothelial neoplasia. Mitomycin C used after transurethral resection of bladder tumor to reduce recurrences, BCG intravesical immunotherapy to treat high risk non-muscle invasive bladder cancer and urothelial carcinoma in situ, and platinum-based systemic chemotherapy to improve post-cystectomy disease-specific survival some of the causes of therapy related atypia in urinary bladder. In addition, a number of systemic drugs in use to treat other systemic diseases, such as cyclophosphamide used to treat certain auto-immune disorders or hematologic malignancies, or the anesthetics ketamine increasingly used as illegal recreational drug, may produce similarly relevant atypical changes in the urothelium, and therefore, need to be differentiated from intraepithelial neoplasia. Immunohistochemical approach to reactive urothelium from CIS using CK20, p53, and CD44 may also be of utility in the pos-therapy scenario.
Eosinophilic cystitis in the pediatric population: A case series and review of the literature
2013, Journal of Pediatric Urology
Eosinophilic cystitis is a rarely seen condition in the pediatric population with indistinct symptomatology and non-standardized treatment protocols. We review our experience of treating patients with this condition.
We retrospectively reviewed the records of four patients from a single institution who have been diagnosed and treated for eosinophilic cystitis. In addition, the literature was reviewed for cases of pediatric eosinophilic cystitis. Our patients were added and compared to this cohort.
Our patients included 3 females and 1 male who range in age from 5 days to 18 years (5 days, 1 month, 7 years, 18 years). Both of the infants presented with a suprapubic mass and bilateral hydroureteronephrosis. The two older patients both had dysuria while the 18 yo also complained of fatigue, flank pain, and hematuria. Only 2 of the 4 patients were found to have significant peripheral eosinophilia and only one patient had eosinophiluria. All of the patients were diagnosed via cystourethroscopy with biopsy. Treatment in each case consisted of a combination of steroids, antihistamines, and antibiotics.
The presentation of eosinophilic cystitis is varied and diagnosis requires a high index of suspicion. Cystourethroscopy with biopsy is essential to establish the diagnosis as there is no typical appearance of the lesions or presenting signs/symptoms. Most cases of eosinophilic cystitis are responsive to medical therapy although in some cases recurrence may be noted.
Benign Diseases of the Bladder
2008, Surgical Pathology Clinics
Benign diseases of the bladder often present diagnostic challenges to practicing pathologists due to their diverse nature and ability to mimic a variety of epithelial or mesenchymal neoplasms. Categories of benign bladder disease include infectious cystitis, noninfectious cystitis, reactive proliferative processes, and benign processes that secondarily involve the bladder. An understanding of the key clinical and morphologic features of these lesions and the useful ancillary techniques specific for these entities is critical to the correct diagnosis of these lesions. This article reviews the key features of these benign bladder diseases and highlights methods to distinguish these lesions from other benign and malignant processes involving the bladder.
Eosinophilic Cystitis Induced by Bacillus Calmette-Guerin (BCG) Intravesical Instillation
2007, Urology
Citation Excerpt :
Factors such as food allergens, parasites, and drugs have been implicated in the genesis of eosinophilic cystitis. Acute eosinophilic cystitis after intravesical instillations, such as mitomycin2 or thiotepa3 for treatment of superficial bladder cancer, and dimethyl sulfoxide4 (DMSO) for treatment of interstitial cystitis, have been documented. However, this is the first reported case of eosinophilic cystitis occurring after intravesical BCG therapy.
Eosinophilic cystitis is a rare and uncommon inflammatory bladder disease, in which the pathophysiology is unclear; only a few cases of such disease induced by intravesical instillations have been described. We report a case of eosinophilic cystitis after intravesical bacillus Calmette-Guerin (BCG) instillation for nonmuscle-invasive transitional cell carcinoma of the bladder. To our knowledge, this report is the first case of eosinophilic cystitis induced by intravesical BCG therapy.
Eosinophilic cystitis after bladder instillation with dimethyl sulfoxide
2004, Urology
Eosinophilic cystitis is a rare and poorly understood disorder. We report the first case of an acute flare of eosinophilic cystitis in a 51-year-old woman after bladder instillation with dimethyl sulfoxide (DMSO) for presumed interstitial cystitis. The patient presented with severe bladder pain, fever, and eosinophilia several hours after instillation. These symptoms were unresponsive to conventional analgesic and antibiotic treatments. Cystoscopy revealed erythema and exudate at the bladder walls, along with edema of both ureteral orifices. Bladder biopsies demonstrated massive eosinophilic infiltration of the bladder, confirming the diagnosis of eosinophilic cystitis. Urologists should bear in mind this clinical entity, particularly when DMSO is administered to patients with multiple drug allergies.
Eosinophilic cystitis in adults
2001, Journal of Urology
We describe the largest clinical experience with the diagnosis and management of largely anecdotally reported eosinophilic cystitis.
Five women and 12 men 18 to 84 years with proved eosinophilic cystitis were treated in a 23-year period. Some combination of hematuria, irritative voiding, dysuria and suprapubic pain was present in 14 cases (82%). The remaining 3 patients (18%) were asymptomatic and the diagnosis was made by cystoscopy done because of a history of bladder carcinoma. Available data included no peripheral eosinophilia in 10 of 10 patients studied, pyuria in 12 (92%), microhematuria in 11 of 13 (84%), sterile urine in all 17, abnormal urine cytology in 2 of 17 (12%), bilateral hydronephrosis in 1 and a bladder mass or thickening in 2. Cystoscopy showed erythema in all cases and tumor-like lesions or edema in 3 (17.6%). Histological studies revealed eosinophilic cystitis in all 17 patients, while in 1 with no history of bladder carcinoma eosinophilic cystitis coexisted with carcinoma.
Two patients were lost to followup and the remaining 15 were followed 1 to 37 months. After biopsy and fulguration of the lesions 10 patients received no further treatment, including 6 with complete symptom resolution and 1 with improvement. The 3 asymptomatic patients with a history of bladder carcinoma remained asymptomatic and disease-free. Another 4 patients underwent medical therapy and improved, of whom 1 had recurrence that was successfully re-treated medically. The remaining patient, who was symptomatic, underwent cystoprostatectomy for end stage bladder disease.
Manifestations of eosinophilic cystitis indistinguishably mimic those of other inflammatory and malignant bladder disorders that may precede or coexist with it. The condition usually follows a benign course in most cases but occasionally its relentless progression causes crippling disease.

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Case reportIntravesical thiotepa-induced eosinophilic cystitis

Abstract

J Urol

J Urol

J Pediatr

Urol Clin North Am

J Urol

J Urol

Eosinophilic cystitisa case associated with possible hydatid infection

Med J Aust

Case report
Intravesical thiotepa-induced eosinophilic cystitis