Role of Cystitis Cystica et Glandularis and Intestinal Metaplasia in Development of Bladder Carcinoma

Objectives: Cystitis cystica et glandularis (CCEG) and intestinal metaplasia (IM) have been suggested to represent precursors of bladder adenocarcinoma. The relationship between these entities and the subsequent development of bladder carcinoma remains unclear. Methods: We retrospectively evaluated the association among florid CCEG, IM, and bladder carcinoma. The records and imaging findings of patients with a pathologic diagnosis of florid CCEG and/or IM were reviewed for a concurrent or future diagnosis of bladder carcinoma or pelvic lipomatosis. Results: We identified 136 patients from 1982 to 2006 with florid CCEG (n = 117) or IM (n = 19). Of the 117 patients with CCEG, a subset was identified with concurrent mucinous adenocarcinoma (n = 1; <1%), squamous cell carcinoma (n = 4; 3%), or urothelial carcinoma (n = 34; 29%) at diagnosis. Pure IM was identified concurrently with adenocarcinoma in 2 (10%), urothelial carcinoma in 4 (21%), and urothelial carcinoma with glandular differentiation in 1 (5%) of 19 patients. Follow-up for 103 patients (75%) ranged from 7 days to 23.7 years (median 2.6 years, mean 4.4). Only 1 new case of urothelial carcinoma was identified after 3 months in 1 patient with CCEG. None of the patients in our series had associated pelvic lipomatosis. Conclusions: Both florid CCEG and IM can be identified in benign bladder specimens or in conjunction with bladder carcinoma. Although IM can be associated with a concurrent diagnosis of carcinoma, we found no evidence that it increases the future risk of malignancy and our findings do not support a recommendation for surveillance cystoscopy in such patients. No association was identified between either CCEG or IM and pelvic lipomatosis.