Case 146.

Tuberculous cystitis after intravesical BCG innoculation (56 y-o M)

		Biopsy from multifocal ulcerative inflammation of the bladder, after BCG therapy for superficial bladder cancer

		Key words :	Mycobacterium bovis, BCG, cystitis, prostatitis, mortar kidney, endometritis

Caseous granuloma caused by BCG (Mycobacterium bovis) is a rare complication of intravesical BCG innoculation therapy (HE).		Numerous acid-fast bacilli are observed within the granulomatous lesion (Ziehl-Neelsen).
Reference case 146A Histologic features of tuberculous prostatitis in a 77 y-o male (HE).　In case of prostatic tuberculosis, tuberculous epididymitis is commonly associated. When the lesion is seen after intravesical BCG innoculation against bladder cancer, the possibility of BCG (M. bovis)-induced granuloma should also be considered.		Reference case 146B Gross features of renal tuberculosis (70 y-o female).　Foci of caseous necrosis in the renal parenchyma are characteristic of so-called "mortar kidney".
Reference case 146C Tuberculous endometritis in a 35 y-o female who visited the hospital for evaluating infertility (endometrial biopsy, HE, low power).　Infertility is caused by tuberculous salpingitis.		Reference case 146C Higher powered view of tuberculous endometritis (endometrial biopsy, HE).　Although no caseous necrosis is seen, the features of granulomatous endometritis are highly suggestive of tuberculosis.
Reference case 146C Endometrial cytologic examination showing clusters of epithelioid cells with lymphocytic reaction (Papanicolaou).　Cytologic recognition of epithelioid cells is important to make an appropriate diagnosis of tuberculosis.