Pathologic Pattern of Invasive Bladder Carcinoma: Impact of Bilharziasis
Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006, 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department, Cairo, Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type, stage, grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9%) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7%), squamous cell carcinoma (SCC) in 51 (34.5%), adenocarcinoma in 9 (6.1%) and anaplastic tumor in 4 (2.7%) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23%, pT3 in 70.9% and pT4a involving the prostate or seminal vesicles in 6.1%. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6%) and high grade in 76 (51.4%) specimens. Regional lymph node involvement was detected in 31 (20.9%) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3, low-grade SCC and commonly appears as an ulcerative, bulky, fungating or verrucous mass. On the other hand, bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation.
Africain Journal of Urology Vol. 14 (2) 2008: pp. 90-97