BLOK NEOPLASIA

TREMATODA HATI :Clonorchis sinensis

Opisthorchis 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 haematobium

telur

Pathogenesis & Clinical symptom :

• skin rash at site of cercarial penetration (swimmer’s 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 ( cont’d) • 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