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Diagnosis: Pyeloureteritis Cystica
Discussion: Pathologically, the lesions in question are benign suburoeipthelial cysts. These are a common finding at the time of cystoscopy and known as (cystitis cystica). Gross examination reveals small, discrete translucent, grayish, cystic bodies, commonly located in the trigone and vicinity of the ureteral orifices. Most commonly found in the bladder, they are also seen in the ureters and renal pelvis and referred to ureteritis cystica and pyelitis cystica. The pathogenesis is unclear, but is speculated to be due to inward invaginations of clusters of epithelial cells, which become detached from the mucosa and subsequently undergo degeneration. Consequently, epithelial blind cysts are found in a submucosal location. Diabetics seem to be predisposed. The findings are most common in females. The most common infectious organism is E-coli.
The differential diagnosis includes several entities: 1) Multifocal transitional cell carcinomas. In this case, identification of the papillomatous interstices of the tumor filled with contrast should be noted. 2) Vascular scalloping secondary to hypertrophy of the gonadal veins. 3) Air bubbles secondary to retrograde injection which are noted to have smoother, more circular configuration and tend to change position freely from one film to another. The fourth would be multiple intraluminal filling defects such as clots or stones, which would also be noted to change in position.
References:
Witten DM, Meyers GH, Utz DC. Emmets Clinical Urography.
W. B. Saunders Company. Philadelphia; 1977:873-876.
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