Urinary Bladder Biopsies Research Articles

MP72-06 QUANTITATIVE ANALYSIS OF MAST CELL INFILTRATION IN INTERSTITIAL CYSTITIS-IS IT STILL SPECIFIC TO INTERSTITIAL CYSTITIS?

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis1 Apr 2016MP72-06 QUANTITATIVE ANALYSIS OF MAST CELL INFILTRATION IN INTERSTITIAL CYSTITIS-IS IT STILL SPECIFIC TO INTERSTITIAL CYSTITIS? Yoshiyuki Akiyama, Daichi Maeda, Teppei Morikawa, Akiteru Goto, Yasuhiko Igawa, Masashi Fukayama, and Yukio Homma Yoshiyuki AkiyamaYoshiyuki Akiyama More articles by this author , Daichi MaedaDaichi Maeda More articles by this author , Teppei MorikawaTeppei Morikawa More articles by this author , Akiteru GotoAkiteru Goto More articles by this author , Yasuhiko IgawaYasuhiko Igawa More articles by this author , Masashi FukayamaMasashi Fukayama More articles by this author , and Yukio HommaYukio Homma More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1619AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mast cell infiltration has been documented as a key pathological feature of interstitial cystitis (IC). However, previous evidence is based on eye-measured/semi-quantitative mast cell counts, which can often be inaccurate and arbitrary. In this study, we used image analysis software to precisely count the number of infiltrating mast cells in IC biopsy specimens. In addition, by comparing IC specimens and non-IC specimens, we attempted to determine whether mast cell infiltration is an IC-specific histological feature. METHODS We quantified mast cells by immunohistochemistry in urinary bladder biopsy specimens taken from 27 patients with Hunner type IC (HIC) (n = 54, one each from the lesion and a non-lesion area), 39 patients with non-Hunner type IC (NHIC) (n = 39), and 15 non-IC patients with chronic cystitis (n = 23, including 8 from non-cancerous area of bladder cancer) using image analysis software. Mast cells were identified by immunostaining with anti-mast cell tryptase antibody. For specimens including detrusors, mast cells in the detrusors were evaluated separately in the same manner. RESULTS No significant differences in the number of mast cells were observed between HIC and non-IC cystitis specimens. In NHIC specimens, mast cell count was significantly lower than HIC and non-IC cystitis specimens (Fig. 1A). Detrusors were included in 6, 11, 21 and 15 specimens from the lesion of HIC, a non-lesion area of HIC, NHIC and non-IC cystitis, respectively. There were no significant differences in the number of mast cells in detrusors between IC and non-IC cystitis biopsy specimens (Fig. 1B). CONCLUSIONS The results indicate that there is no increase in the number of mast cell tryptase-positive cells in either entire specimen or detrusor areas of IC biopsy specimens compared to non-IC biopsy specimens, suggesting that mast cell infiltration is not a specific histological feature of IC in biopsy specimens. The diagnostic significance of mast cell counts in IC biopsy specimens is questionable. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e954 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yoshiyuki Akiyama More articles by this author Daichi Maeda More articles by this author Teppei Morikawa More articles by this author Akiteru Goto More articles by this author Yasuhiko Igawa More articles by this author Masashi Fukayama More articles by this author Yukio Homma More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Hunner-Type (Classic) Interstitial Cystitis: A Distinct Inflammatory Disorder Characterized by Pancystitis, with Frequent Expansion of Clonal B-Cells and Epithelial Denudation.

Interstitial cystitis (IC) is a chronic bladder disease with urinary frequency, bladder discomfort or bladder pain of unknown etiology. Based on cystoscopic findings, patients with IC are classified as either Hunner-type/classic IC (HIC), presenting with a specific Hunner lesion, or non-Hunner-type IC (NHIC), presenting with no Hunner lesion, but post-hydrodistension mucosal bleeding. Inflammatory cell infiltration, composed predominantly of lymphocytes, plasma cells and epithelial denudation, has in the past been documented as a major pathological IC finding. However, the significance of the pathological evaluation of IC, especially with regard to the difference between HIC and NHIC, has been downplayed in recent years. In this study, we performed immunohistochemical quantification of infiltrating T-lymphocytes, B-lymphocytes and plasma cells, and measured the amount of residual epithelium in urinary bladder biopsy specimens taken from patients with HIC and NHIC, and those with no IC, using image analysis software. In addition, in situ hybridization of the light chains was performed to examine clonal B-cell expansion. Lymphoplasmacytic infiltration was significantly more severe in HIC specimens than in NHIC specimens (P <0.0001). Substantial lymphoplasmacytic inflammation (≥200 cells/mm2) was observed in 93% of HIC specimens, whereas only 8% of NHIC specimens were inflamed. Plasmacytic infiltration was more prominent in HIC specimens compared with NHIC and non-IC cystitis specimens (P <0.005). Furthermore, expansion of light-chain-restricted B-cells was observed in 31% of cases of HIC. The amount of residual epithelium was decreased in HIC specimens compared with NHIC specimens and non-IC cystitis specimens (P <0.0001). These results suggest that NHIC and HIC are distinct pathological entities, with the latter characterized by pancystitis, frequent clonal B-cell expansion and epithelial denudation. An abnormality in the B-cell population may be involved in the pathogenesis of HIC.

Histopathological study of cystoscopic bladder biopsies

Background: Urinary bladder diseases constitute an important source of clinical signs and symptoms which are more disabling than lethal. The prevalence of bladder tumor in developed countries is approximately six times higher compared with that in developing countries. The aim of this study was to find out various lesions in urinary bladder biopsies and its frequencies.Materials and Methods: This was a five year retrospective study from January 2008 to December 2013, carried out at B&amp;B Hospital, Lalitpur. All the relevant data of 324 patients who had undergone cystoscopic biopsy of urinary bladder were included in the study. All blocks were retrieved and stained with Hematoxylin and Eosin stain and examined under light microscope.Results: The spectrum of pathological lesions included inflammations and tumors. Non-neoplastic lesions were predominant (61.11%) followed by Transitional cell tumors accounted for 124 cases (38.27%). Non-neoplastic lesions comprises of cystitis and tuberculosis. Papillary urothelial neoplasms was the most common tumors seen in this study with 55 low grade, and 54 high grade Papillary urothelial carcinoma according to recent WHO grading. Single cases each of adenocarcinoma and paraganglioma were diagnosed.Conclusion: Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions. Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions in our country.Journal of Pathology of Nepal (2015) Vol. 5, 717-719

Study of the reproducibility of the 2004 World Health Organization classification of urothelial neoplasms

The aim of the study was to evaluate urinary bladder biopsies showing papillary urothelial neoplastic lesions based on the 2004 WHO/ISUP classification of Urothelial Neoplasms of the Urinary Bladder, to assess the reproducibility of the bladder carcinoma grade. Fifty consecutive transurethral tumor resection biopsies were evaluated by four pathologists independently. The final diagnoses of each pathologist were subjected to statistical analysis to assess the degree of interobserver variability and reproducibility of this classification. Significant interobserver variation was found in the reporting of urothelial neoplasms. In 22 instances there was difference in opinion between PUNLMP and low-grade carcinoma, and in 59 instances between low and high grade carcinoma. The 4 observers never unanimously agreed on the diagnosis of PUNLMP.

Altered Expression of Transmembrane Mucins, MUC1 and MUC4, in Bladder Cancer: Pathological Implications in Diagnosis

PurposeRadical changes in both expression and glycosylation pattern of transmembrane mucins have been observed in various malignancies. We and others have shown that MUC1 and MUC4, two transmembrane mucins, play a sentinel role in cell signaling events that drive several epithelial malignancies. In the present study, we investigated the expression profile of MUC1 and MUC4 in the non-neoplastic bladder urothelium, in various malignant neoplasms of bladder and in bladder carcinoma cell lines.Material and MethodsImmunohistochemistry was performed on tissue sections from the urinary bladder biopsies, resection samples and tissue microarrays (TMAs) with monoclonal antibodies specific for MUC1 and MUC4. We also investigated their expression in bladder carcinoma cell lines by RT-PCR and immunoblotting.ResultsMUC1 is expressed on the apical surface or in umbrella cells of the normal non-neoplastic bladder urothelium. Strong expression of MUC1 was also observed in urothelial carcinoma (UC). MUC1 staining increased from normal urothelium (n = 27, 0.35±0.12) to urothelial carcinoma (UC, n = 323, H-score, 2.4±0.22, p≤0.0001). In contrast to MUC1, MUC4 was expressed in all the layers of non-neoplastic bladder urothelium (n = 14, 2.5±0.28), both in the cell membrane and cytoplasm. In comparison to non-neoplastic urothelium, the loss of MUC4 expression was observed during urothelial carcinoma (n = 211, 0.56±0.06). However, re-expression of MUC4 was observed in a subset of metastatic cases of urothelial carcinoma (mean H-score 0.734±0.9).ConclusionThe expression of MUC1 is increased while that of MUC4 decreased in UC compared to the normal non-neoplastic urothelium. Expression of both MUC1 and MUC4, however, are significantly higher in urothelial carcinoma metastatic cases compared to localized UC. These results suggest differential expression of MUC1 and MUC4 during development and progression of bladder carcinoma.

Sjögren’s syndrome accompanied with interstitial cystitis: a case report and review of the literature

We present a case report of a patient with Sjögren's syndrome accompanied with interstitial cystitis. A 64-year-old woman complained of dry mouth for 21years, recurrent swelling and pain on the right parotid in 2000, and urinary irritation symptoms in the past 2years. Several courses of different types of antibiotics could not relieve her urinary irritation symptoms. Bladder hydraulic dilatation had only transient effects. Urine sediment contained neither erythrocytes nor leukocytes, and urine cultures yielded no growth. However, increased γ-globulin, positive antinuclear antibodies, and anti-SS-A and anti-SS-B antibodies were detected. Histopathological data of labial salivary glands showed three foci of numerous mononuclear cells. Cystoscopy revealed redness, edema, angiectasis, and extensive ecchymosis of the mucosal surface and several small floating cruor entities in the bladder. Urinary bladder biopsy specimens revealed the absence of urothelium and edematous lamina propria and submucosa, with diffuse or multiple focal chronic inflammatory cell infiltration. Based on these findings, she was diagnosed with Sjögren's syndrome accompanied with interstitial cystitis. Therapy with corticosteroids relieved the symptoms significantly.

Podoplanin (D2-40) is a Reliable Marker of Urinary Bladder Myofibroblasts (Telocytes)

Podoplanin, D2-40, has been described in a variety of normal and neoplastic tissues. It is often used for highlighting lymphatics. We evaluated the expression of podoplanin in α-smooth muscle actinpositive myofibroblasts producing the suburothelial layer in tunica propria of the urinary bladder that have some similar features with telocytes. Our results showed that these cells demonstrate distinct D2-40 immunoreactivity from telocytes occurring in the renal pelvis and ureter. We observed positive reaction not only in bioptic specimens from women with interstitial cystitis, but also in a control group of women and men treated for pathological bladder lesion different from interstitial cystitis. It is interesting that identical staining reaction was observed in the ureters only exceptionally. In addition, we examined samples from myofibroblastic tumoriform lesions of soft tissue such as nodular fascitis and fibromatosis (desmoid) and we obtained negative results. It means that the so-called myofibroblasts of urinary bladder tunica propria have a unique immunophenotype that has probably not been described until now. Our findings suggest that D2-40 can be used as a complementary immunostainer to α-smooth muscle actin on urinary bladder biopsies from patients with interstitial cystitis. The role of D2-40 as an immunohistochemical marker is still being investigated.

Study of Urothelial Neoplasm in Central India With Reference To WHO/ISUP Grading

Introduction: Urothelial carcinoma is the most common bladder cancer, is often described as a polyclonal field change defect with frequent recurrence due to heightened potential for malignant transformation. Urothelial neoplasm runs the gamut from small benign neoplasm that may never recur to tumors of lower indeterminate malignant potential to lesions that invade the bladder wall and metastasize frequently. Hence histologic grading of these tumors to predict behavior has been subject of great debate as there is poor inter - observer reproducibility and no uniformity. Material and Methods: The present study was carried out in the Department of Pathology, L.N. Medical College, Bhopal, India. It was both a prospective and a retrospective study of 80 patients whose urinary bladder biopsy were studied. Result: 80 cases reported out of which 20 were transitional papilloma, 52 were cases of ransitional cell carcinoma and 8 cases were of squamous cell carcinoma. The majority of tumours are present in age group of 50-80 years. Discussion: Although World Health Organization classification system is most commonly used grading system but lack of detailed histological criteria motivated WHO and ISUP to publish a consensus classification for urothelial neoplasm of urinary bladder. The majority of the cases in this study belonged to the histologic grades of papillary carcinoma of low grade which corresponds to the WHO classification of transitional cell carcinoma grade II.

THU0480 AA-Amyloidosis as Diagnostic Clue of a Family with Atypical Cryopirin Associated Periodic Syndrome with Muckle-Wells Syndrome Phenotype

BackgroundCryopyrin-associated periodic syndromes (CAPS) are dominantly inherited autoinflammatory diseases (AD) caused by NLRP3 mutations. They include different phenotypes (FCAS, Muckle-Wells syndrome, and CINCA/NOMID) with different severity, usually as childhood onset...

Nephrogenic Adenomas in Pediatric Patients: A Morphologic and Immunohistochemical Study of 21 Cases

Similar to nephrogenic adenomas in adults, those in children are rare benign lesions that often occur in the setting of previous surgery or chronic irritation of the urinary tract. These lesions often present with hematuria and/or as polypoid or papillary lesions on cystoscopy, which may indicate malignancy. We sought to evaluate the various patterns of nephrogenic adenoma occurring in the pediatric population and better characterize the immunophenotype of these lesions. We reviewed 21 cases of nephrogenic adenomas from urinary bladder biopsies of 16 patients. Most patients had a history of urinary bladder augmentation with recurrent urinary stones and urinary tract infections. Many cases presented as a papillary or polypoid mass on cystoscopy. The most common morphologic patterns are papillary, tubulocystic, and a mixed pattern of papillary and tubulocystic, followed by cystic and tubular. On immunostaining, PAX-2, PAX-8, CK7, and MUC-1 provided the most diffuse and intense positive reactivity for nephrogenic adenoma, whereas CD10 and P504S were focal and lesser in intensity when positive. p63 and PAX-5 were consistently negative. We conclude that, although rare in children, nephrogenic adenoma should be included in the differential diagnosis of papillary/polypoid lesions in the urinary tract, especially in the context of previous surgery, chronic irritation from recurrent urinary tract infections, or stones. The immunohistochemistry profile of nephrogenic adenomas in our study also provides evidence that these are derived from distal renal tubular cells. In difficult cases, an immunohistochemical panel consisting of cytokeratin 7, PAX-2, PAX-8, and MUC-1 may be useful.

Comparison of urine protein profiles in cats without urinary tract disease and cats with idiopathic cystitis, bacterial urinary tract infection, or urolithiasis

To characterize and compare the urine protein content in cats without urinary tract disease and cats with idiopathic cystitis (IdC), bacterial urinary tract infection (UTI), or urolithiasis. Control cats (n = 18) and cats with IdC (18), UTI (12), and urolithiasis (12) from which urine samples were obtained and 2 cats with obstructive IdC and 4 additional control cats from which postmortem urinary bladder biopsy specimens were obtained. Protein contents in urine samples obtained via cystocentesis or catheterization were measured via the Bradford method. Urine proteins were separated by means of 1-dimensional gel electrophoresis. Evaluation of fibronectin content was performed via western blotting and immunohistochemical analysis. Urinary bladder biopsy specimens were examined histologically and analyzed immunohistochemically for fibronectin. Urine fibronectin content was significantly greater in cats with IdC, compared with control cat findings. Urine fibronectin contents did not differ significantly among controls and cats with UTI or urolithiasis. Histologic examination of bladder biopsy specimens obtained from 2 cats with obstructive IdC revealed destruction of the urothelial lining of the urinary bladder and severe fibrosis; immunohistochemical analysis revealed few fluorescence signals for fibronectin, unlike findings in control bladder biopsy specimens. Results indicated that urine fibronectin content in cats with IdC was greater than that in controls, cats with UTI, or cats with urolithiasis. In cats with IdC, increased permeability of damaged urothelium may result in detachment and leakage of fibronectin into urine. Urine fibronectin might serve as a biomarker for diagnosis of IdC in cats.

Bladder cancer in Lagos: a 15 year histopathologic review

To present a 15 year retrospective pathologic study of bladder cancers. The aim is to document histologic pattern, prevalence, sex and age distribution of urinary bladder cancer. The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all urinary bladder biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1991 to 2005. Each sample represents a different patient. The study did not include information regarding the clinical or pathological stage of the tumours. Bladder malignancies comprised 39 (72.2 %) cases of all bladder biopsies and 0.86% of all diagnosed cancers in LUTH. The malignant lesions of the bladder showed a male preponderance with a M:F ratio of 4.6:1. The age range was 4-75 years with a mean age of 51.37 years and peak at 61-70 years age group. Transitional cell carcinoma was the commonest histological type accounting for 61.5% with a male to female ratio of 5:1 and mean age of 59 years. Squamous cell carcinoma accounted for 20.5% with a M:F ratio of 3:1 and showed a mean age of 47 years. Adenocarcinoma, anaplastic carcinoma and embryonal rhabdomyosarcoma accounted for 5.1%, 5.1% and 7.8% of cases respectively. Bladder cancer is not common in Lagos. The histopathologic pattern, prevalence, sex and age distribution of bladder cancer are similar to previous reports from schistosomiasis non endemic regions of Nigeria, Africa and the rest of the world.

Validation of World Health Organization/International Society of Urologic Pathology 2004 Classification Schema for Bladder Urothelial Carcinomas Using Quantitative Nuclear Morphometry: Identification of Predictive Features Using Bootstrap Method

Despite the introduction of the new World Health Organization 2004 grading classification, the grading of urothelial carcinoma remains difficult and subjective. The aim of this study was to evaluate the role of computer-assisted image morphometric analysis as a tool to improve the objectivity of histologic grading of urothelial carcinoma. A total of 75 urinary bladder biopsies from a cohort of patients with a first-time diagnosis of urothelial carcinoma representing low-grade (n = 19) and high-grade (n = 56) urothelial carcinoma were evaluated. Quantitative nuclear morphometry was performed on these biopsies using approximately 80 to 100 cells per case. A total of 17 nuclear morphometry features were extracted, and a bootstrap-based predictor selection using stepwise logistic regression analysis was performed. Subsequently, a validation was performed using the five top features from the logistic regression analyses by implementing a nonparametric discriminant analysis to identify the most discriminative features that predicted for high-grade cases. The bootstrap technique included nuclear pleomorphism as the most frequently selected predictor of high-grade urothelial carcinoma (in 213 of 500 replicates). Validation using the top five features in the logistic regression analysis method (pleomorphism, configuration run length, DNA mass, feret-Y, and age) using discriminant analysis gave a resubstitution error of 4%, indicating the usefulness of the selected predictors. The present study is the first to provide a morphometric validation of the World Health Organization 2004 system for pathologic grading of bladder cancer. Furthermore, quantitative nuclear morphometry could aid in the objective grading of urinary bladder biopsies. This information might aid the treating physicians in better risk stratification of patients with urothelial carcinoma.

Upregulation of fibroblast growth factor receptor 3 and epidermal growth factor receptors, in association with Raf‐1, in urothelial dysplasia and carcinoma in situ after the Chernobyl accident

The present study was carried out in order to examine the molecular status of selected growth factor receptors (GFR) in urinary bladder lesions, recently described by our group as representing 'Chernobyl cystitis'. Fibroblast growth factor receptor 3 (FGFR3), epidermal growth factor receptor 1 (EGFR1), EGFR2neu (a member of the same family), p53 and Raf-1 serine/threonine kinase expression were evaluated immunohistochemically in urinary bladder biopsies from 22 men with benign prostate hyperplasia (group 1). For comparison, 16 men with benign prostate hyperplasia and five women with chronic cystitis living in non-radio-contaminated areas of the country were also investigated as controls (group 2). Additionally, 14 patients with dysplasia, carcinoma in situ (CIS) and primary urothelial carcinoma (UC) operated before the Chernobyl accident as well as 23 patients with UC living in the radio-contaminated areas were included as pre- and post-Chernobyl UC groups 1 and 2, respectively. Chronic proliferative atypical cystitis ('Chernobyl cystitis') was observed in group 1 patients. Foci of dysplasia and CIS were found in 22 (100%) and 19 (86%) of the 22 cases, respectively; moreover, two small UC were also detected. Elevated levels of FGFR3, EGFR2/neu, p53 and to a lesser extent EGFR1 and Raf-1 expression in the urothelial dysplasia and CIS were evident for patients of group 1. Statistically significant differences in immunohistochemical scores for FGFR3, EGFR1, p53 and Raf-1 were observed between groups 1 and 2 and between group 1 and the post-Chernobyl UC group 2, where a change in expression of EGFR2/neu was also noted. A significant decrease in FGFR3 expression in additional pre-Chernobyl UC group 1 with dysplasia, CIS and UC compared with group 1 Chernobyl cystitis cases was detected. Our findings suggest that FGFR and EGFR signaling pathways, associated with p53 and Raf-1 activation, may contribute to multistage urothelial carcinogenesis caused by irradiation, through autocrine or paracrine growth stimulation.

Aberrant expression of E‐cadherin and β‐catenin in association with transforming growth factor‐β1 in urinary bladder lesions in humans after the Chernobyl accident

This study examines the molecular pathways of cell-cell communication in chronic inflammatory processes associated with long-term low-dose urinary bladder exposure to ionizing radiation in people without major disease living more than 19 years in radio-contaminated areas of Ukraine after the Chernobyl accident. Patterns of components of the E-cadherin/beta-catenin complex, and transforming growth factor-beta1 (TGF-beta1) and inducible nitric oxide synthase (iNOS) expression were immunohistochemically evaluated in urinary bladder biopsies from 52 males with benign prostate hyperplasia and 8 females with chronic cystitis (group 1). For comparison, 25 males and 6 females living in non-contaminated areas of Ukraine were also investigated (group 2). Fourteen patients with primary urothelial carcinomas, which were operated on before the Chernobyl accident, were included as a carcinoma group. Chronic proliferative atypical cystitis ('Chernobyl cystitis') was observed in group 1 patients. Foci of dysplasia and carcinoma in situ were found in 51 (85%) and 34 (57%) of the 60 cases, respectively. Chronic cystitis with areas of dysplasia was detected in only 4 (13%) cases of 31 group 2 patients. Statistically significant differences in immunohistochemical scores for TGF-beta1 in the urothelium and lamina propria, iNOS in the urothelium and both beta-catenin and E-cadherin in the cytoplasm were observed between groups 1 and 2 with marked expression in group 1. Furthermore, TGF-beta1 overexpression and alteration in E-cadherin/beta-catenin complexes in bladder urothelium might play a crucial role in urinary bladder carcinogenesis in humans exposed to long-term low-dose ionizing radiation.

Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returning from Africa

Several cases of therapeutic failure of praziquantel used for the treatment of urinary schistosomiasis have been reported. Alternative drugs, like niridazol and metrifonate, have shown a lower therapeutic effect and more side effects than praziquantel. Twenty-six Brazilian military men (median age of 29 years) with a positive urine parasitological exam who were part of a United Nation peace mission in Mozambique in 1994 were treated with 40 mg/kg body weight praziquantel, single dose. They swam in Licungo river (Mocuba city, Mozambique) during the weekends. After this, they presented haematuria, dysuria, polakiuria, and lumbar pain. Control cystoscopy examinations carried out between 6 and 24 months after each treatment (including two additional treatments at a minimum interval of 6 months) revealed the presence of viable eggs. Granulomas in the vesical submucosa were observed in 46.2% (12/26) of the individuals. A vesical biopsy confirmed the presence of granulomas in all of these patients and the presence of viable eggs in 34.3% (9/26) of individuals who no longer excreted eggs in urine. The eggs filled with miracidia showed characteristics of viability. Histopathological examination using different strains demonstrated therapeutic failure and the need for repeated treatment. In this study, we demonstrated a low efficacy of praziquantel in the treatment of schistosomiasis haematobia, and the necessity of the urinary bladder biopsy as criterion of cure.

Carcinoma Of The Urinary Bladder In Maiduguri, Nigeria: A Retrospective Histopathological Study Of 100 Cases

AIMS: This study was conducted with the aim of determining the histopathological pattern, age and sex distribution of 100 cases of carcinoma of the urinary bladder in Maiduguri as well as highlight some of the associated aetiological factors. METHODS: One hundred urinary bladder biopsies were received in the department of histopathology of the U M T H, Maiduguri. The specimens were previously fixed in 10% formalin. They were processed, sectioned and stained with standard haematoxylin and eosin stains. The records of patients were collected from our surgical daybooks. Patients with incomplete demographic data as well as Metastatic carcinomas were excluded from the study. Simple statistical analysis was used in analyzing the cases. RESULTS: Squamous cell carcinoma was the commonest tumour and accounted for 70% of the cases. Transitional cell carcinoma constituted 22%. The least common tumours were embryonal rhabdomyosarcoma and carcinosarcoma contributing one case each. Of the 70 cases of squamous cell carcinoma, 41 cases (58.6%) had associated vesical schistosomiasis. Fifty nine percent of cases were in the fifth and sixth decades of life. The tumour is three times more common in males than in females. CONCLUSION: The high frequency of association of carcinoma of the bladder with schistosomiasis in our environment calls for serious attention by our clinicians to the eradication of schistosomiasis. This will by far reduce the number of cases of urinary bladder carcinoma associated with schistosomiasis. KEY WORDS: Carcinoma of the urinary bladder; Histopathological pattern; Squamous cell; Schistosomiasis. Highland Medical Research Journal Vol.2(1) 2004: 41-44

Changes in End Products of Nitric Oxide in Urine and Induction of Nitric Oxide Synthase Expression in Urinary Bladder During Intravesical Instillations of IFN-α2b

Interferon-alpha2b (IFN-alpha2b) is being used intravesically for preventing recurrence and progression of superficial transitional cell carcinoma of the bladder. However, its mechanism of action when instilled intravesically is not yet elucidated. We monitored end products of nitric oxide (NO) in urine in 12 bladder cancer patients undergoing intravesical instillations of IFN-alpha2b. Urine end products of NO levels rose gradually after each instillation, reaching a peak value after the third instillation. Although the patients continued their treatment for 5 more weeks, no further alteration was observed. Inducible nitric oxide synthase (iNOS) expression was immunohistochemically evaluated in urinary bladder biopsy specimens before and after IFN-alpha2b instillations. It was shown that IFN-alpha2b induced urothelial iNOS expression, with subsequent oxidative stress. The peroxynitrite (ONOO-) formed from the combination of NO with superoxide (O2-) provides important clues in the role of ONOO- as a causative factor in the antineoplastic action of IFN-alpha2b.

Changes in End Products of Nitric Oxide in Urine and Induction of Nitric Oxide Synthase Expression in Urinary Bladder During Intravesical Instillations of IFN-α2b

Interferon-α2b (IFN-α2b) is being used intravesically for preventing recurrence and progression of superficial transitional cell carcinoma of the bladder. However, its mechanism of action when instilled intravesically is not yet elucidated. We monitored end products of nitric oxide (NO) in urine in 12 bladder cancer patients undergoing intravesical instillations of IFN-a2b. Urine end products of NO levels rose gradually after each instillation, reaching a peak value after the third instillation. Although the patients continued their treatment for 5 more weeks, no further alteration was observed. Inducible nitric oxide synthase (iNOS) expression was immunohistochemically evaluated in urinary bladder biopsy specimens before and after IFN-α2b instillations. It was shown that IFN-α2b induced urothelial iNOS expression, with subsequent oxidative stress. The peroxynitrite (ONOO–) formed from the combination of NO with superoxide (O2–) provides important clues in the role of ONOO– as a causative factor in the antineoplastic action of IFN-a2b.

Urinary bladder biopsy with denuded mucosa: denuding cystitis-cytopathologic correlates.

Denuding cystitis is often encountered in tissue biopsies of bladder mucosa performed by either cold-cup forceps or wire loop electrocautery to evaluate hematuria or to rule out recurrent urothelial carcinoma. Lack of urothelium in these biopsies is often a frustrating experience, leading to a nonspecific interpretation. In this study, 151 cases of denuding cystitis were retrieved from the surgical pathology files of The Johns Hopkins Hospital over a 4-year period (1996-1999). Patients under the age of 40 years and outside consultation material were excluded. Of the 151 cases of denuding cystitis, 48 patients were identified who had concurrent urinary cytologic studies. Of these patients, 35 were male (73%) and 13 were female (27%). Patient ages ranged from 43 to 85 years (mean, 67). Twenty-six of these 48 patients (54%) had at least one concurrently positive urinary cytology, which was histologically confirmed. All except three cases were high-grade urothelial carcinoma with the following histologic subtypes: flat carcinoma in situ (n = 11), noninvasive papillary (n = 9), and invasive urothelial carcinoma (n = 3). We conclude that urinary cytology is a sensitive modality that detects exfoliated carcinoma cells in patients with a histologic diagnosis of denuding cystitis. An inconclusive diagnosis of denuding cystitis on tissue might be related to biopsy method and technique, small sample size, or biopsy of cystoscopically abnormal urothelium that is denuded. A cytologic diagnosis of high-grade urothelial carcinoma in these cases leads to a timely clinical intervention for optimal patient management.