Urothelial carcinoma of the urinary bladder mixed with squamous differentiation or squamous cell carcinoma in areas with schistosomiasis is showing high risk of recurrence and poor survival

In schistosomiasis haematobium areas endemic, bladder cancer is the first cause of malignancy in men and fourth in women. The chronic schistosomiasis would lead to variant histologic patterns which manifest in squamous cell carcinoma [SCC] or squamous differentiation [SqD]. This study evaluated the clinical outcome after radical cystectomy [RC] in patients with urothe-lial carcinoma [UC] mixed with SCC or SqD, Comparison was done with two arms of pure UC and pure SCC, indication for RC was muscle-invasive-disease, and evaluation included recurrence, metastases, and overall survival. The data of patients treated with RC for muscle-invasive-disease, selection was revised for 127 patients with urothelial carcinoma mixed with SCC/SqD, two comparative arms were 100 patients with pure UC, and 100 patients had pure SCC. Follow up was on 8 months, Syears, and 5 years to detect recurrence, metastasis, and overall survival in the three groupsThe results showed that by comparison of disease aggressiveness in the three groups regarding recurrence, metastasis, and overall survival was analysed. Overall survival with mixed tumours was significantly lower than pure UC or SCC, recurrence and metastases were higher in mixed tumour which was an independent factor for poor prognosis and low survival

Tumour necrosis factor production in patients with carcinoma of the bladder associated with bilharziasis

Tumour necrosis factor [TNF] is produced by activated macrophages in response to the presence of a malignant tumour. In this study we evaluated the level of TNF in patients bearing carcinoma of the bladder with bilharziasis in comparison either to similar patients who underwent surgical procedures or even normal individuals. Twenty three patients eight of whome were bearing cancer bladder associated with bilharziasis. The remaining fifteen patients had a surgical intervention for removal of their cancer bladder. They underwent either total cystectomy with urine diversion [11 cases] or transurethral resection with or without intravesical therapy [4 cases]. The TNF level in the urine and serum of the 23 patients was assayed. The TNF level in urine and serum of 11 normal individuals [control] was also measured. The mean value of TNF level in the urine and serum of patients who underwent different surgical procedures [10.78 pg/ml. and 16. 2pg/ml] was higher when compared to the normal control [4.68 pg/ml and 12.77 pg/ml]. Also the mean value of the TNF level in the urine of the same group of patients was higher than the group of patients who had cancer bladder associated with bilharziasis before treatment [6.814 pg/ml]. Yet, there was a slight decrease in the mean value of the TNF level in the serum of the postoperative group when compared to the preoperative [17.375 pg/ml] although it was statistically insignificant. At the same time it was found that patients with carcinoma of the bladder associated with bilharziasis had a significantly higher TNF level in serum and urine [P<0.01 and P<0.05] when compared to normal individuals. Our conclusion was that TNF level assay in the urine and serum of patients bearing cancer bladder associated with bilhariziasis after being surgically treated is of an insignificant value since there are many factors to interplay [metabolic, metastasize, recurrence intravesical therapy. Also it is possible to take the TNF level whether in urine or serum of patients having cancer bladder associated with bilharziasis before treatment as an indication to the existance of the malignant tumour