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Presented by George Netto, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 5: A 47 year old west African male presented with urinary frequency and hematuria.
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1. Question
Week 319: Case 5
A 47 year old west African male presented with urinary frequency and hematuria. On imaging studies his urinary bladder revealed extensive mural calcifications. A transurethral biopsy was obtained./images/5B_7_30_07.jpg
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Answer: Urinary bladder Schistosomiasis with extensive calcifications
Histology: Numerous calcified Schistosomal eggs can be seen with the characteristic terminal spine of S. Haematobium. Associated urothelial mucosa shows no evidence of squamous or urothelial carcinoma.
Discussion: S. Haematobium are tramatodes that have been extensively linked to squamous cell carcinoma (SCCa) of urinary bladder. In geographic locals where S. Haematobium is endemic such as west Africa, south and south east Africa and the Nile valley, squamous cell rather than urothelial carcinoma (URCa) is the predominant histologic type of bladder cancer. Pathogenetically, chronic irritation with associated squamous metaplasia, inflammation and oxidative stress/damage is thought to play a role in the carcinogenesis. Changes in the metabolism of mutagenic agents in patients with Schistosomal infections could also paly a role. Schistosomal associated SCCa is usually present in a background of squamous metaplasia like the one seen in our case. At the molecular genetic level, Schistosomal associated SCCa appears to share many of the alterations that have been documented in “sporadic” UCa tumors. These include the presence of p53 and HRAS mutations, EGFR and HER2 overexpression and loss of chromosomal 9 regions.
Reference(s):
– Mohammed AZ, Edino ST, Samaila AA. Surgical pathology of schistosomiasis. J Natl Med Assoc. 2007 May;99(5):570-4.
– Abdel Wahab AH, Abo-Zeid HI, El-Husseini MI, Ismail M, El-Khor AM. Role of loss of heterozygosity on chromosomes 8 and 9 in the development and progression of cancer bladder. J Egypt Natl Canc Inst. 2005 Dec;17(4):260-9.Incorrect
Answer: Urinary bladder Schistosomiasis with extensive calcifications
Histology: Numerous calcified Schistosomal eggs can be seen with the characteristic terminal spine of S. Haematobium. Associated urothelial mucosa shows no evidence of squamous or urothelial carcinoma.
Discussion: S. Haematobium are tramatodes that have been extensively linked to squamous cell carcinoma (SCCa) of urinary bladder. In geographic locals where S. Haematobium is endemic such as west Africa, south and south east Africa and the Nile valley, squamous cell rather than urothelial carcinoma (URCa) is the predominant histologic type of bladder cancer. Pathogenetically, chronic irritation with associated squamous metaplasia, inflammation and oxidative stress/damage is thought to play a role in the carcinogenesis. Changes in the metabolism of mutagenic agents in patients with Schistosomal infections could also paly a role. Schistosomal associated SCCa is usually present in a background of squamous metaplasia like the one seen in our case. At the molecular genetic level, Schistosomal associated SCCa appears to share many of the alterations that have been documented in “sporadic” UCa tumors. These include the presence of p53 and HRAS mutations, EGFR and HER2 overexpression and loss of chromosomal 9 regions.
Reference(s):
– Mohammed AZ, Edino ST, Samaila AA. Surgical pathology of schistosomiasis. J Natl Med Assoc. 2007 May;99(5):570-4.
– Abdel Wahab AH, Abo-Zeid HI, El-Husseini MI, Ismail M, El-Khor AM. Role of loss of heterozygosity on chromosomes 8 and 9 in the development and progression of cancer bladder. J Egypt Natl Canc Inst. 2005 Dec;17(4):260-9.
