Its clinical expression is not very specific with most asymptomatic cases. Some patients complain of cystitis to varying degrees, such as pollakiuria, urinary urgency and dysuria. Hematuria remains the most common tell-tale sign 20. The clinical examination is poor but in case of trigonal localization, obstructive symptoms may appear. The pseudo-tumor proliferative form causes intramural compression of the distal ureteral segments and development of uretero-hydronephrosis or even chronic renal failure late.

Due to the absence of characteristic ultrasound signs of CGK, except for exophyte papillary lesions that cause irregular thickening of the bladder wall, Ultrasound has only an orientation value and can only provide recommendations for further evaluation 21. Computed Tomography is the reference study of the urinary shaft in its entirety and contributes to the investigation of the causal factor such as kidney stones as in our case or a pelvic lipomatous. It often shows a simulated appearance of vesical carcinoma as in this observation by thickening the tissues and infiltration of the base of the bladder 22. The MRI by its sequences and different planes shows an infiltration of the peri-vesical fat, of the para-vesical muscles by the lesion evaluating its locoregional evolutionary stage. Therefore, there is no indication of MRI in the diagnosis of glandular cystitis because there are no specific signs of differentiation with a malignant bladder injury 23.

At the same time allows a direct vision of the bladder lesion, to show its macroscopic appearance, its topography, its extension and the carrying out of biopsies in various places, essential for the final diagnosis. It objective an exophytic polypoid or nodular vesicle mass, sometimes ulcerated with a broad implantation base 24 with a mucosa usually presenting a pavement pattern. The final diagnosis is made only by pathology.

Cytologically, urine tests are negative in most cases, but an experienced pathologist may suggest the diagnosis of glandular cystitis which must be confirmed by histology 25.

In histology, in a first phase, the proliferation of urothelial cells to the chorion, leads to the formation of "nests VON BRUNN". These islets or nests of urothelial cells develop a central light. This light is lined with secreting cells giving rise to the formation of real glandular structures that can take on a pseudo-colonic appearance with the presence of goblet cells. Sometimes, the light from these islets of VON BRUNN extends to form real cysts containing colloid matter. At this stage, the separation between cystic and glandular cystitis is not histologically well defined.

Immunohistochemistry comes to highlight features not visible in simple histology. Chromogranin immunostaining highlights spindle-shaped endocrine cells in the nests of Von Brunn, of glandular cystitis 26 between the epithelial cells and contains intracytoplasmic neuroendocrine granules positive for silver staining of Grimelius.

Ultimately, the histological immune analysis makes it possible to distinguish the frequent pure cystic cystitis, as in our observation, developed from the islets of Von Brunn cyslized with accumulation of mucin, of the glandular form or the unstratified muciparous cells form glands in the superficial chorion without atypia or mitosis 27.

However, an anatomohistochemical correlation is important because glandular cystitis is considered as a pre-cancerous lesion, generating adenocarcinoma, unlike cystic cystitis which is without risk of malignant transformation.

The differential diagnosis really arises only for tubular or tubulopapillary pseudo-tumor forms which must be distinguished 28,

Infiltrating adenocarcinoma of the bladder and the florid form of glandular metaplasia with real pseudo-tumor masses 29. There are 3 types, primary adenocarcinoma, uracic adenocarcinoma and metastatic adenocarcinoma.

Endo-cervicosis described for the first time by Clement and Young in 1992 appears only in women 30. It is in the form of a painful isolated bladder nodule of variable size up to 3 cm at the level of the bladder dome and the posterior wall of the bladder. Histologically, it is characterized by glands located exclusively in the musculature unlike glandular cystitis where the glandular structures are in the lamina propria.

From the nephrogenic adenoma described by Davis in 1949 for the first time 31. Histologically, the tubular structure is common under the urothelium without deep muscle invasion.

Treatment for this condition should be based on eliminating the causative factor of bladder irritation by long-term antibiotic therapy and / or lithotripsy and transurethral surgical excision of the bladder inflammation area.

Cystectomy is reserved for rare serious cases of extensive lesions with recurrent hematuria and obstruction of the urinary tract. Endo vesical instillations of hydrocortisone or low molecular weight heparin or antihistamine may improve symptoms without any effect on the tumor 32.

The evolution of glandular or cystic cystitis is favorable and disappears after removal of the pathological areas and treatment of the favorable causes. However, some causes do not have a cure for complete healing, such as pelvic lipomatosis for example. In these rare cases, the transformation into a bladder adenocarcinoma is certain and estimated at 0.5 to 1% of bladder tumors 33.