Carcinoma of the bilharzial urinary bladder.A study of the associated mucosal lesions in 86 cases

Abstract

The mucosal lesions in the lower urinary tract were examined in 86 cystectomy specimens of bilharzial bladder cancer. Squamous cell carcinoma occurred in 66 cases, transitional cell carcinoma in 18 cases, and adenocarcinoma in two cases. Multiple infiltrative carcinomas were found in 19 cases (22.1%), and these were commonly of the transitional cell type (63.9%). Squamous metaplasia was found in 65.1%, columnar metaplasia in 52.3%, and carcinoma in situ in 40.7%. The ureters, trigone, and urethra were rarely affected by these lesions. Carcinoma in situ was more commonly associated with multiple carcinomas (68.4%) than with single tumors (32.8%). Squamous metaplasia was found in 81.8% of squamous cell carcinomas and in 16.7% of transitional cell carcinomas. The two cases of adenocarcinoma were associated with columnar metaplasia in the adjacent mucosa. Squamous cell carcinoma and adenocarcinoma probably arise from metaplastic epithelium. Total or subtotal cystectomy is recommended because of the high incidence of carcinoma in situ (40.7%) and multiple carcinomas (22.1%).

Bladder Cancer in Iraq: The Histological Subtypes and their Relationship to Schistosomiasis

“…Such changes are also seen in patients with urinary bladder cancer and schistosomiasis. Our findings parallel those of Khafagy et al 20 in Egypt. Thus a similar metaplasia-dysplasia-carcinoma sequence can be postulated in chronic vesical schistosomiasis in Iraq.…”

Schistosomasis and Bladder Cancer

“…The carcinoma usually arises from the upper vesical hemisphere, at the posterior wall or vault. The trigone is rarely the site of the tumor origin (2%) ( Khafagy et al,1972) in contradistinction to the non-shistosoma associated cancer bladder where it involved in 21% ( Mostofi,1975). …”

“…In the Schistosoma infested urinary bladder, the urothelium usually undergoes various metaplastic, proliferative and atypical changes ( Khafagy et al, 1972). Metaplasia refers to a change in cell type, and this explains the histogenesis of non-transitional tumors in the bladder.…”

“…The SABC is frequently associated with a variety of pathologic changes in the bladder mucosa including: leucoplakia, cystitis cystica, carcinoma in situ and different schistosoma lesions (Zahran et al, 1976). In a series of Khafagy et al, (1972) of SABC 26 % of cases showed squamous metaplasia, 53 % of these lesions were non-keratinizing and 29 % showed surface keratinization and 18 % showed basal cell hyperplasia and atypia ( Figure. 2). Columnar metaplasia in the form of Brunn's nests, cystitis glandularis and cystica was observed in 52%-63 % (Khafagy,et al, 1972& Zahran et al, 1976) of cystectomy specimens.…”

“…In a series of Khafagy et al, (1972) of SABC 26 % of cases showed squamous metaplasia, 53 % of these lesions were non-keratinizing and 29 % showed surface keratinization and 18 % showed basal cell hyperplasia and atypia ( Figure. 2). Columnar metaplasia in the form of Brunn's nests, cystitis glandularis and cystica was observed in 52%-63 % (Khafagy,et al, 1972& Zahran et al, 1976) of cystectomy specimens. Cystitis glandularis with atypia has been described by El-Bolkainy & Chu (1981a) at the tumor margin of adenocarcinoma.…”