BLOK NEOPLASIA

TREMATODA HATI : Clonorchis sinensis Opisthorchis viverrini

TREMATODA DARAH: Schistosoma haematobium

Schistosoma haematobium
Geographic 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 haematobium

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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

Epidemiologi
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