Is Schistosomiasis a Red Herring in Carcinoma of the Bladder?
AbstractObjective: The specific role Schistosoma ova play in bladder carcinogenesis as well as its association with a specific morphologic subtype has remained inconclusive. This study aims to re-evaluate this relationship morphologically and review the literature. Materials: A 19-year (1999-2017) review of all cases of carcinoma of the bladder with or without schistosomiasis was conducted. This was supplemented with a review of the literature. Results: 278 cases of carcinoma of the bladder were diagnosed. These comprised 251 males and 27 females in ratio 9:1 and mean ages 56±15 years and 54±16 years respectively (p 0.6). While none of the 27 carcinomas among females had Schistosoma ova 28 of the 251 carcinomas in males were co-morbid with schistosomiasis. These comprised 13 of the 174 TCC, 14 of the 94 SCC, and 1 of the 10 adenocarcinomas. There were no statistically significant differences in gender (p 0.6), age (p 0.6), or co-morbidity with the parasite (p 0.2) among the various histologic subtypes. A review of the literature shows an association of Schistosoma ova not only with SCC but also with TCC and, but for isolated case reports, there is a paucity of definitive association with cancers outside the bladder. Conclusion: There were no statistically significant differences in gender, age, or co-morbidity with the parasite among the various histologic subtypes. In addition to this, the literature review suggests there must be other co-factors present only in the bladder, rather than just the ova by itself, responsible for Schistosoma-associated carcinoma in this organ.
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