Urinary Retention Due to Benign Tumor of the Bladder Neck in a Woman; A Rare Case of Papillary Cystitis

Background Urinary retention (UR) is not common in women. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional. As opposed to the male, obstructive UR is unusual in women. Methods A 56-year-old woman presented with urinary retention. She reported difficulty in urination for more than 15 days. She had no history of urinary tract infection, bladder surgery and catheterization. Her physical examination revealed a soft tissue mass obstructing the external orifice of the urethra. After its partial removal the patient regained her ability to urinate. Results The patient underwent urological investigation. Ultrasound examination of the urinary system was normal. Cystoscopic examination revealed a papillary lesion with broad base floating along the bladder neck. The patient underwent transurethral resection of the bladder tumor. Discussion Pathological examination diagnosed papillary cystitis. She was scheduled for a regular follow-up with urine cytology, ultrasound and cystoscopy. One year after diagnosis the patient remains free of symptoms and no recurrence was observed. Conclusions Papillary and polypoid cystitis are benign lesions, however under certain circumstances they should be considered in the differential diagnosis of transitional cell carcinoma of the bladder. Lack of the prominent inflammation and edema that characterizes both papillary and polypoid cystitis, and absence of a history of recent bladder catheterization and presence of vesical fistula may facilitate the decision to biopsy the lesion. To our knowledge, this is the first case of papillary cystitis presenting with urinary retention in a woman to be reported in the literature.

Pseudoneoplastic Mimics of Prostate and Bladder Carcinomas

Context.—The differential diagnoses of prostatic carcinoma and bladder epithelial neoplasms include several histologic mimics that should be known to avoid misdiagnosis. Objective.—To discuss pseudoneoplastic lesions of the prostate and bladder that could potentially be confused with prostatic carcinoma and bladder epithelial neoplasms, respectively, with specific focus on their distinguishing histopathologic features. Data Sources.—Relevant published literature and authors' experience. Conclusions.—Pseudoneoplastic lesions in the prostate include those of prostatic epithelial origin, the most common being atrophy, adenosis (atypical adenomatous hyperplasia), basal cell hyperplasia, and crowded benign glands, as well as those of nonprostatic origin, such as seminal vesicle epithelium. Such lesions often mimic lower-grade prostatic adenocarcinoma, whereas others, such as clear cell cribriform hyperplasia and granulomatous prostatitis, for example, are in the differential diagnosis of Gleason adenocarcinoma, Gleason grade 4 or 5. Pseudoneoplastic lesions of the urinary bladder include lesions that could potentially be confused with urothelial carcinoma in situ, such as reactive urothelial atypia, and others, such as polypoid/papillary cystitis, where papillary urothelial neoplasms are the main differential diagnostic concern. Several lesions can mimic invasive urothelial carcinoma, including pseudocarcinomatous hyperplasia, von Brunn nests, and nephrogenic adenoma. Diagnostic awareness of the salient histomorphologic and relevant immunohistochemical features of these prostatic and urinary bladder pseudoneoplasms is critical to avoid rendering false-positive diagnoses of malignancy.