BLOK NEOPLASIA

TREMATODA DARAH:
Schistosoma haematobium

Schistosoma haematobium
Geographic Distribution :
Africa (54 countries) , ex: Egypt, Sudan,
Zambia,

Malawi, and Zimbabwe,
Eastern Mediterranean
180 million people live in endemic areas and
90 million are infected with the parasites

Hospes definitif:
Manusia, Baboon dan sejenisnya

causes urinary schistosomiasis,
(schistosomal hematuria,vesical
schistosomiasis, or urinary bilharziasis)

source: http://www.dpd.cdc.gov/dpdx/HTML/Schistosomiasis.htm

Schistosoma haematobium
Pathogenesis & Clinical symptom :
skin rash at site of cercarial penetration
(swimmers itch)
it is the eggs not the adult flukes which are
responsible for the clinical features
egg deposits in the bladder mucosa and
submucosa were seen during the acute phase
Continuous aggravation in the bladder
wall leads to carcinoma of the bladder

Pathogenesis ( contd)
damage to the bladder or ureters :
obstructed and the bladder wall thickened
abnormal bladder function with painful
frequent urination, urinary infection
(cystitis )
eventually kidney damage.
hematuria is the most characteristic
symptom.


The Relationship Between Schsitosomiasis
and Bladder cancer

Prevalence :
Carcinoma of the urinary bladder is the
most common malignancy in the Middle
East and parts of Africa where
schistosomiasis haematobium

is a
widespread problem
The major histological cell type of bladder
cancer is Squamous Cell Carcinoma

Cancer of the bladder
In Egypt : 60 % of the Egyptian population is at

risk of infection.
Prevalence of 37 to 48% with high incidence
In Iraq : The proportion of SCC varied from
54 to 81% of all

bladder cancer cases in
different areas of endemic infection,

which
contrasts to Western countries, where the
frequency of SCC

in bladder cancer cases is
much lower (3 to 10%)
Cancer of the Bladder
eggs can act as a

mechanical irritant to the
urothelium
it was also found that endogenous levels of
host

cell DNA damage were related to the
intensity of infection.
chronic inflammatory

lesions
continuous exposure to the carcinogens,

e.g.,
N-nitroso compounds, which were detected in
larger quantities

in the urine of patients with
schistosomiasis

Control
Treated Mice
Histo-pathological changes
Epidemiology
Age and Gender Ratios :
In schistosome-free countries : the peak incidence
of bladder cancer is in the 6 th or 7 th decade

( max
between the ages of 65 and 75 years)
By contrast, in endemic countries : the mean age is
between 40 and 49 years
The ratio of bladder cancer

incidence (males to
females) in countries with endemic infection

was
reported to be 5:1

LABORATORY DIAGNOSIS:

Specific :
Finding the eggs or occasionally the hatched
miracidia in the urine
occasionally, eggs can be found in faeces
detecting eggs in rectal biopsy or bladder
mucosal biopsy
Biopsy of the mucosal bladder