Primary nonurachal adenocarcinoma in the bilharzial urinary bladder: deoxyribonucleic acid flow cytometric and morphologic characterization in 93 cases.

OBJECTIVES: To characterize adenocarcinomas of the urinary bladder by their DNA profiles and their proliferative properties. METHODS: Primary nonurachal adenocarcinomas, found in 93 patients with bilharzial bladder carcinomas, were studied using DNA flow cytometry. Tumor ploidy and S-phase fraction were related to tumor grade, stage, cell type, and lymph node status. RESULTS: Aneuploidy with high S-phase fractions, found in 90% of the tumors, demonstrates the high malignancy potential of these tumors, the majority of which were found to be muscle-infiltrative. There were no relationships between ploidy or S-phase fraction and tumor grade and stage. Lymph node metastases, present in 24% of the 93 patients, were found exclusively in nontetraploid aneuploid tumors with high S-phase fractions exceeding 100%. Paraffin-embedded tissues compared with fresh material gave the same information on ploidy, whereas bladder washing did not provide adequate information. CONCLUSIONS: The high aggressiveness of adenocarcinomas in the biharzial bladder is confirmed and can be explained by their proneness to develop gross chromosomal aberrations combined with high cell proliferation.