BLOK NEOPLASIATREMATODA HATI :Clonorchis sinensisOpisthorchis viverrini

TREMATODA DARAH:Schistosoma haematobium

Schistosoma haematobiumGeographic Distribution :Africa (54 countries) , ex: Egypt, Sudan, Zambia, Malawi, and Zimbabwe, Eastern Mediterranean

Hospes definitif:Manusia, Baboon dan sejenisnya

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

Schistosoma haematobiumtelur

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 phaseContinuous aggravation in the bladder wall leads to carcinoma of the bladder

Pathogenesis ( contd) damage to the bladder or ureters : obstructed and the bladder wall thickenedabnormal 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 problemThe major histological cell type of bladder cancer is Squamous Cell Carcinoma

Cancer of the bladderIn Egypt : 60 % of the Egyptian population is at risk of infection. Prevalence of 37to 48% with high incidenceIn Iraq : The proportion of SCC varied from 54to 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 (3to 10%)

Cancer of the Bladder eggs can act as a mechanical irritant to the urotheliumit 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

EpidemiologyAge 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 65and 75years)By contrast, in endemic countries : the mean age is between 40and 49yearsThe 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 urineoccasionally, eggs can be found in faecesdetecting eggs in rectal biopsy or bladder mucosal biopsy

Biopsy of the mucosal bladder

Biopsy of Bladder cancer

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