Upper urinary tract obstruction from cystitis glandularis with intestinal metaplasia, on a background of radical prostatectomy and adjuvant radiation therapy: A case report

Abstract

Background Cystitis glandularis refers to a metaplastic change in the bladder urothelium. It is a common phenomenon, and the literature has yet to reach a consensus on whether this is a premalignant lesion. Cystitis glandularis with intestinal metaplasia, a rarer subtype, has been hypothesised to be a precursor to adenocarcinoma. The purpose of this report is to explore this connection and its potential relationship with prostate cancer and radiotherapy. Case presentation A 60-year-old male presented with biochemical recurrence following a radical prostatectomy and adjuvant external beam radiation therapy (EBRT). Investigations showed right sided hydroureteronephrosis and renal impairment. Imaging revealed right-sided posterolateral bladder wall thickening with involvement of the right vesicoureteric junction (VUJ). A bladder lesion was found via cystoscopy and the patient underwent a transurethral resection of bladder tumour (TURBT). Histopathology revealed cystitis glandularis with intestinal metaplasia. Discussion and Conclusions Some studies have demonstrated an association between cystitis glandularis with intestinal metaplasia and adenocarcinoma, including genetic changes suggestive of oncogenic variants. While the history of prostatic adenocarcinoma with EBRT in this patient is a risk factor for developing bladder carcinoma, it has not been demonstrated that upper urinary tract obstruction has greater premalignant potential, and the absence of dysplastic features in this patient confers a lower risk. Although limited therapeutic advances have been made, the current treatment recommendations for cystitis glandularis with intestinal metaplasia include endoscopic resection and ongoing cystoscopic surveillance.