Geburtshilfe Frauenheilkd 2015; 75 - P004
DOI: 10.1055/s-0035-1555027

Are Mast Cells still good Biomarkers for Bladder Pain Syndrome/Interstitial Cystitis?

S Regauer 1, M Gamper 2, J Welter 2, J Eberhard 2, V Viereck 2
  • 1Inititut für Pathologie; Medizinische Universität Graz, Graz, Österreich
  • 2Department of Gynecology and Obstetrics; Cantonal Hospital Frauenfeld, Frauenfeld, Schweiz

Einleitung:

The hallmark of overactive bladder syndrome (OAB) is urgency and of bladder pain syndrome/interstitial cystitis (BPS/IC) pain accompanied by a persistent urge to void or urinary frequency, but overlapping symptoms complicate clinical diagnosis. European Society for the Study of Interstitial Cystitis (ESSIC) guidelines require > 28 mast cells in 1 mm2 detrusor muscle as a diagnostic histological criterion for BPS/IC. This study provides a comparative assessment of mast cell counts, distribution, and activation in bladder biopsies of 12 BPS/IC with Hunner's lesions, 19 BPS/IC without Hunner's lesions, 13 OAB, and 12 bladder-healthy patients control patients.

Material:

Biopsies were analyzed with HE stains for type of infiltrate and immunohistochemically with antibody to mast cell tryptase for WHO criteria for neoplastic mastocytosis (major criterion increased mast cells and 3 minor criteria CD25 expression, spindling of mast cells in > 25%, elevated serum tryptase levels). Statistical analyses included Kruskal-Wallis, Mann Whitney U, Fisher's exact tests, and receiver operating characteristic (ROC) curves for mast cell counts.

Ergebnisse:

Lymphocytic infiltration (p = 0.001), nodular lymphocyte aggregates (p < 0.001), and urothelial abnormality (p < 0.001) were identified in biopsies of BPS/IC patients with Hunner's lesion. Subepithelial localization (p < 0.001) and amount of detrusor mast cells (p = 0.029), but not mast cell activation (p = 0.21) or total submucosal mast cell numbers (p = 0.089) distinguished BPS/IC with Hunner's lesion from the other groups. The optimal cutoff value for detrusor mast cell counts was 32 cells/mm2. Neoplastic disease was not identified. 50% BPS/IC patients with Hunner's lesion had concomitant autoimmune diseases. Allergies or drug/food intolerances were found in all patient groups.

Zusammenfassung:

Nodular lymphocytic infiltrates, urothelial defects and subepithelial mast cell location were indicative of BPS/IC with Hunner's lesion. We conclude that biopsy recommendations of the ESSIC are too stringent and the use of 'detrusor mast cell counts' as sole histological diagnostic criterion for BPS/IC ought to be critically re-evaluated.