Schistosomiasis of the Urinary Bladder.

A young man presented with recurrent gross hematuria. Cystoscopy revealed the presence of polypoid mucosa and ulceration. These lesions were biopsied, and histologic evaluation led to the identification of Schistosoma haematobium eggs, with numerous ova containing miracidia and an eosinophil-rich inflammatory infiltrate (Figure 1). Which of the following is associated with schistosomiasis of the urinary bladder?a.Marginal zone lymphomab.Adenocarcinoma of the urinary bladderc.Squamous cell carcinoma of the urinary bladderd.Nephrogenic adenoma/metaplasia Answer: c. Squamous cell carcinoma of the urinary bladder In S. haematobium endemic areas (ie, Africa and portions of the Middle East), chronic schistosomiasis frequently involves the urinary bladder. Eggs deposited within perivesicular venules migrate through the bladder wall and may be identified by examination of the urine or, as in this case, on histopathologic evaluation (Figure 2). Mature S. haematobium eggs are large (110 to 170 μm long by 40 to 70 μm) and display a terminal spine. In some instances, calcified eggs may also be identified radiographically. These patients frequently present with localized ulceration, hematuria, and obstructive symptoms. Persistent injury can lead to keratinizing squamous metaplasia and is a risk factor for the development of squamous cell carcinoma.1Bowa K. Mulele C. Kachimba J. Manda E. Mapulanga V. Mukosai S. A review of bladder cancer in Sub-Saharan Africa: a different disease, with a distinct presentation, assessment, and treatment.Ann Afr Med. 2018; 17: 99-105Crossref PubMed Scopus (8) Google Scholar,2El-Sebaie M. Zaghloul M.S. Howard G. Mokhtar A. Squamous cell carcinoma of the bilharzial and non-bilharzial urinary bladder: a review of etiological features, natural history, and management.Int J Clin Oncol. 2005; 10: 20-25Crossref PubMed Scopus (0) Google Scholar Schistosoma haematobium is the only Schistosoma that routinely infects the venules around the bladder; other common pathogenic species including Schistosoma mansoni and Schistosoma japonicum are typically resident in the venules of the large and small intestine.