Expression of CD44 protein in bilharzial and non-bilharzial bladder cancers

OBJECTIVES: To investigate the expression of CD44 protein in bilharzial and non-bilharzial bladder carcinomas, and to relate the results of immunohistochemistry to the established prognostic factors, as studies clearly show that altered adhesive function of tumour cells is important in the metastatic process and CD44 is assumed to be critical in the malignant progression of many human tumours. PATIENTS AND METHODS: The study included 55 patients with bladder carcinoma confirmed by cystoscopy and biopsy. Of the 33 patients with transitional cell carcinoma (TCC), 19 were bilharzial and 14 non-bilharzial, and of 22 with squamous cell carcinoma (SCC), 12 were bilharzial and 10 non-bilharzial. CD44 expression was measured by immunohistochemical analysis of paraffin-embedded tissue obtained from these patients after appropriate treatment (transurethral resection, partial or radical cystectomy). RESULTS: There was significantly less CD44 expression in invasive TCC than in normal urothelium and pre-invasive TCC (P = 0.05). The expression of CD44 was inversely related to the tumour grade and depth of invasion (P = 0.05). However, there was no such relation for SCC; there was no significant difference between CD44 expression in metaplastic squamous epithelium, pre-invasive and invasive SCC. The presence or absence of bilharzial ova had no apparent effect on the expression of CD44, with no significant difference between CD44 expression in bilharzial and non-bilharzial bladder carcinomas. CONCLUSIONS: These data confirm that there is a reduction in CD44 expression with increasing tumour grade and stage of TCC, and may provide an additional aid in predicting the progression of this tumour. There was no such relationship with SCC, and no difference between CD44 expression in bilharzial and non-bilharzial bladder carcinomas.     

Stenting versus non-stenting after non-complicated ureteroscopic manipulation of stones in bilharzial ureters

BACKGROUND: Stents were used routinely after ureteroscopy to prevent postoperative ureteral obstruction. However, because of the recognized complications of stents, non-stenting is the new trend after uncomplicated ureteroscopy. The wall of the bilharzial ureter is characteristically thick and may be calcified. The aim of this study is to see if the non-stenting trend could be applied to ureteroscopic manipulation of stones in bilharzial ureters. PATIENTS AND METHODS: In this prospective study, 56 patients, with evidence of bilharzial lesions in the urinary tract, undergoing ureteroscopy for distal ureteral stones were included. After successful uncomplicated stone fragmentation and extraction, patients were randomized into two groups. Group A includes 28 patients in whom double J 6-Fr polyurethane stents were placed for 3 weeks. Group B includes 28 non-stented patients. Postoperative fever, loin pain, lower urinary tract symptoms and change in the degree of hydronephrosis were reported. RESULTS: There was no significant difference in the mean age of patients and stone size in both groups. The mean operative time was 43 +/- 14 min in group A and 38 +/- 11 in group B. There was no significant difference in the mean loin pain score, in the first postoperative 48 h, in both groups (4.4 +/- 0.8 in group A and 4.9 +/- 0.5 in group B). Patients in group A had, significantly, more flank pain with voiding (P < 0.01), voiding pain (P = 0.04), frequency (P = 0.01) and urgency (P = 0.04). Radiologic follow-up was available for 24 patients in group A and 23 patients in group B at the 3-month visit. Hydronephrosis had improved in all patients, in both groups, with no evidence of ureteral stricture. CONCLUSION: Routine placement of stents after uncomplicated ureteroscopy for distal ureteral stones is unnecessary in bilharzial ureters. Moreover, it might be unadvisable because lower urinary tract symptoms and voiding loin pain are more in patients with ureteral stents and hydronephrosis is equally improved in stented and non-stented patients.     

Schistosomiasis (bilharziasis) and male infertility

Schistosomiasis (bilharziasis) is an endemic parasitic disease of a major source of morbidity and mortality for developing countries. It is caused by different species of blood flukes (trematode worms) of the genus Schistosoma, the most important of which are S. haematobium which infests the genitourinary tract and S. mansoni and S. japonicum which infest the gastrointestinal tract. The incidence of schistosome‐induced male infertility is not known and probably underestimated being overshadowed by the more severe and often fatal urinary and gastrointestinal complications. Several causes may contribute to schistosomiasis‐induced male infertility, such as hormonal imbalance, testicular tissue damage and genital ductal system obstruction, in addition to decreased libido and erectile dysfunction due to associated hormonal imbalance and prostatic infestation. Demonstration of the schistosome ova in seminal plasma or testicular tissue confirms the diagnosis. Treatment of schistosomiasis‐induced male infertility depends on clinical evaluation and includes, besides anthelmintic treatment, hormonal replacement and assisted reproduction (IVF/ICSI) in cases of severe oligozoospermia and or obstructive and nonobstructive azoospermia.     

Sensitive detection of human papillomavirus in cervical, head/neck, and schistosomiasis-associated bladder malignancies

We assayed for the presence of human papilloma virus (HPV) DNA in serum and/or peripheral blood fraction (PBF) of individuals with cervical, head/neck, or bladder cancer due to schistosomiasis. Using mass spectroscopy coupled with competitive PCR, HPV DNA was detected at the individual molecule level by using "MassARRAY" assays. The resultant sensitivity was superior to real-time fluorescent PCR-based assays, while specificity was maintained. Our principal findings were: (i) Virtually all tested cervical cancers and schistosomiasis-associated bladder cancers, and a plurality of head/neck cancers, are associated with HPV DNA in the tumor. (ii) All 27 bladder cancers due to schistosomiasis were associated with the presence of HPV-16 DNA, which can be detected in tumor and serum but not in PBF. In contrast, no serum HPV-16 DNA signal was detected in seven individuals with schistosomiasis-associated bladder cancers after surgical removal of the tumor. (iii) Among the head/neck cancers we studied, anterior tumors were more often associated with HPV DNA in tumor, serum, and/or PBF than posterior tumors. (iv) In cervical cancer, where all tumors contain HPV DNA, viral DNA could be detected often in serum and/or PBF. Further, HPV-16 DNA was detected in serum and/or PBF of most patients with untreated high-grade cervical dysplasia but disappeared if the dysplasia was eliminated. The sensitive, specific, and quantitative MassARRAY technique should make it feasible to monitor cancer occurrence and treatment and recurrence of malignancies and dysplasias associated with HPV DNA.     

CD10 expression in tumour and stromal cells of bladder carcinoma: an association with bilharziasis

CD10 is a cell surface zinc metalloprotease expressed in a variety of normal cell types, including lymphoid precursor cells, germinal centre B lymphocytes and some epithelial cells. The aim of this study was to assess the prognostic value of CD10 in bladder carcinoma. The expression of CD10 was immunohistochemically assessed in 49 cases of primary bladder carcinoma in comparison with 10 non-neoplastic normal bladder mucosa specimens. 27 cases (55%) were tumour CD10(+) and tumour CD10 positivity was significantly correlated with advanced stage, larger tumor size, and shorter mean survival time. Extensive tumoral staining assessed by H score further documented the positive correlation of CD10 with worse prognostic factors in the whole group and its subdivisions (SCC and TCC), in addition to its significant association with bilharziasis in SCC. Only CD10-tumour positivity in the whole group proved to be an independent prognostic factor for overall survival by multivariate analysis. No significant value of stromal CD10 expression in the investigated bladder carcinoma cases was found. This study points to the prognostic value of neoplastic CD10 expression in bladder carcinoma and its possible importance in facilitating tumour invasion and metastasis. Bilharziasis could have a role in upregulation of CD10 expression in SCC.     

新疫区血吸虫病患者心理健康状况调查

目的探讨血吸虫病患者心理健康状况，为新疫区血防工作提供依据。方法采用症状自评量表和自编血吸虫病患者现状调查问卷，对株洲市近郊血吸虫病流行新疫区127例患者进行问卷调查，并与中国常模进行比较。结果症状自评量表测评，血吸虫病患者抑郁、焦虑因子分显著高于常模（P〈0．01），且40a～50a年龄段的抑郁、焦虑因子分均显著高于其他年龄段（P〈0．01）。新疫区居民对血吸虫病防治知晓率高，具有很强的防范意识。结论在进行血吸虫病防治工作的同时，需加强心理卫生保健工作，为提高患者的心身健康水平提供保障。     

Impact of Cyclin D1 and Heterogeneous Nuclear Ribonucleoprotein-K (HnRNP-K) on Urinary Bladder Carcinogenesis

Objective: This study aimed to investigate the expression of cyclin D1 and hnRNP-K in relation to the pathologicalfindings in bladder cancer including the type, grade, muscle invasion and bilharzial association. Methods: We studiedthe immunoexpression; as regard the percentage, intensity and score of both cyclin D1 and hnRNP-K in different bladderlesions including 10 cases of cystitis; 10 cases of carcinoma insitu (CIS), 20 cases of Squamous cell carcinoma (SCC)and 66 cases of urothelial carcinoma (UC). Results: High expression of cyclin D1 was found in UC compared to othergroups (p<0.001) and in UC with low grade, non-muscle invasive and papillary tumors compared to their counterparts(p<0.05, hnRNP-K expression was found in SCC compared to other groups (p <0.001) and in UC with high grade, muscle invasiveand non-papillary tumors compared to their counterparts (p<0.001each). Bilharzial-associated UC showed higherexpression of hnRNP-K percent (p<0.05) compared to non-bilharzial cases. Conclusion: This study elucidated a possiblecontribution of cyclin D1 and hnRNP-K expression in the initiation and progression of urinary bladder carcinoma,so, both of them can be used in predicting progression of urinary bladder carcinoma and to differentiate between UCand SCC in high grade tumors. The possible role of both markers in immunotherapy deserves supplementary studies.