Abstract
Bladder cancer (BCA) is a worldwide disease and shows a wide range of geographical variation. The aim of this study is to analyze the prevalence of schistosomal and non-schistosomal associated BCA as well as compare our findings with the 2004 WHO consensus classification of urothelial neoplasms and with other publications. The archival materials of 180 urinary bladder specimens were collected from Department of Pathology, King Abdul-Aziz University Hospital (KAUH), Jeddah, Western region, Saudi Arabia. The regional prevalence of this cancer was identified and studied, and a comparison between schistosomal and non-schistosomal associated BCA was made. Additionally, the study revised and classified these neoplasms according to the most recent 2004 WHO classification of urothelial neoplasms. The type of mural invasion either muscularis mucosae (MM) or muscularis propria (MP), other associated lesions as carcinoma in situ (CIS) as well as, metaplasia and schistosomal infestation were assessed. Urothelial cell neoplasms (UCN) comprised 161 cases (89.4%), squamous cell carcinoma (SCC) represented 12 cases (6.7%), adenocarcinoma 5 cases (2.8%), and sarcomatoid carcinoma detected in 2 cases (1.1%). Among all these cases schistosomal associated BCA represented 13 cases (7.2%), while the remaining 167 cases (92.8%) were non-schistosomal associated BCA. In the former category, 11 cases (6.1%) were squamous cell carcinoma and 2 (1.1%) urothelial cell carcinoma (UCC) whereas, non-schistosomal associated cancer that included UCN, SCC, adenocarcinoma, and sarcomatoid carcinoma found in 159, one case, 5, and 2 cases. Invasion of muscularis propria was detected in 30 cases (16.7%) and muscularis mucosae invasion in 45 cases (25%). According to WHO classification of urothelial neoplasms accurate categorization of BCA is very important for both diagnostic and therapeutic values.
Highlights
An estimated 68,810 new cases of Bladder cancer (BCA) were diagnosed in the United States in the year 2008 and 14,100 deaths from it were estimated for the same year [1]
Previous studies were mentioned in spite that squamous cell carcinoma is the commonest histological type of BCA its percentage is in decline as with the strategy toward eradication of schistosomiasis [24,25]
The majority of them were complained of lower urinary tract symptoms that ranged from burning micturition to gross hematuria
Summary
An estimated 68,810 new cases of BCA were diagnosed in the United States in the year 2008 and 14,100 deaths from it were estimated for the same year [1]. Schistosomal-associated BCA has distinctive clinicopathological features quite different from other regions worldwide This tumor affects patients at a much younger age with male predilection [20,21,22,23]. Previous studies were mentioned in spite that squamous cell carcinoma is the commonest histological type of BCA its percentage is in decline as with the strategy toward eradication of schistosomiasis [24,25]. Associated with these studies and others, the pattern of histopathology of BCA showed marked change, where SCC constituted less than 60% [26,27,28]. The majority of this malignancy is conventional urothelial cell carcinoma [30]
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