ABSTRACT
Schistosomjasjs is a parasitic disease which is endemic in certain regions in the world as Egypt. One of the most important consequences of this infection is urinary bladder cancer which has a higher rate worldwide. Yet, its incidence shows a wide range of geographical variation. Although the link between schistosomiasis and bladder cancer is generally accepted, the pathophysiological mechanisms are still unclear. Additionally, there are many other risk factors than schistosomiasis may be having an intimate relation with the development of bladder cancer. One of the most important pathological variables related to the staging of urinary bladder cancer is the pathologic tumor [pT]. This factor is essentiaily landmarked by invasion of lamina propria muscularis mucosae [MM], and muscularis propria [MP] by the cancerous cells. The aim of this study is to analyze the various pathological characteristics of schistosomal and non schistosonmi bladder cancer. In the same way is to explore the incidence of this tumor and its geographical relations. As well as to evaluate other associated bladder lesions in relation to this tumor such as carcinoma in situ, types of metaplasia and the degree of inflammatory cells infiltrate in the tumor tissue. Additionally is to assess the different variables of invasion as lamina propria MM and MP invasion. Also, is to analyze the pathological variables of other types of bladder cancers as adenocarcinoma and sarcomatoid carcinoma. Finally is to compare our findings with other previous publications mentioned worldwide. This is an analytical, hospital based case study performed in King Abdul-Aziz University Hospital, Jeddah, Western region, Kingdom Saudi Arabia. The study included [n=180] bladder cancer cases. The regional incidence of bladder cancer was identified and studied, then making comparison between schistosomal and non schistosomal bladder cancer in different countries. Additionally, the study was analyzed the possible risk factors and studying the most recent 2004 WHO classification of urothelial neoplasms. Patients' medical records were reviewed for the clinicoradiological findings. Finally, histopathological examination for all cases was performed. The histological evaluation of these cases included the various types of this cancers and their categorization according to WHO classification. The degree of invasion, associated lesions as carcinoma in situ, metaplasia and the deposition of schistosomal ova were also assessed. Finally, the cases were looked for the inflammatory cells infiltrate including the degree of infiltration in a trial to analyze the value of immune response in disease recurrence and progression. The study was performed on 180 cases of urinary bladder specimens. These specimens included 15 cases [8.3%] radical cystectomy specimens, and the remaining 165 cases [91.7%] were bladder biopsies. The majority of cases studied were urothelial neoplasms, which comprised 161 cases [89.4%]. Additionally, squamous cell carcinoma [SCC] represented 12 cases [6.7%], adenocarcinoma 5 cases [2.8%], and sarcomatoid carcinoma was 2 cases [1.1%]. Among all these cases studied schistosomal bladder cancer represented 13 cases [7.2%] whereas, the remaining 167 cases [92.8%] were non schistosomal bladder cancer. The schistosomal associated cancer cases included II cases [6.1%] SCC and 2 cases [1.1%] were TCC. For tumor invasion, MP invasion was detected in 30 cases 916.7%], and lamina propria MM invasion was observed in 45 cases [25%]. The conclusion of this study includes, in spite that schistosomiasis plays a critical role in the pathogenesis of bladder cancer, there is a wide geographical distribution for schistosomal infestation and hence for the histological types of bladder cancer. Additionally, the majority of bladder cancer in this study is urothelial neoplasms while; the minority is non transitional cell carcinoma. In the same way schistosomal associated bladder cancer represents a minor degree in comparison to endemic areas. Also, there is a major discrepancy in the incidence of this tumor in relation to various countries. As well as there are many other risk factors may be linked to the development of this tumor. Finally, one of the most important prognostic factors for invasive urinary bladder cancer is tumor grade. The corner stone of the pathologic tumor [pT] is the evaluation of the depth of invasive malignant cells in the bladder wall