In a series of 1095 Egyptian patients with carcinoma of the bladder treated by radical cystectomy, 902 cases (82.4%) contained schistosome eggs in the specimens, and 193 (17.6%) were egg-negative. The different tumor parameters were compared in these subgroups to explore any differences that could be related to schistosomal infestation. In egg-positive cases, the tumor developed at a younger age (46.7 years) than in egg-negative cases (53.2 years). Squamous cell carcinoma, commonly of low grade, predominated in the egg-positive group. No difference was observed in the frequency of tumor stages or lymph node metastases between the two subgroups. The limited tendency to distant spread in schistosomal bladder cancer, despite its advanced local stage, is accounted for by the high frequency of low grade tumors rather than the limiting effect of local schistosomal tissue reactions.

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The mucosal lesions in the lower urinary tract were examined in 86 cystectomy specimens of bilharzial bladder cancer. Squamous cell carcinoma occurred in 66 cases, transitional cell carcinoma in 18 cases, and adenocarcinoma in two cases. Multiple infiltrative carcinomas were found in 19 cases (22.1%), and these were commonly of the transitional cell type (63.9%). Squamous metaplasia was found in 65.1%, columnar metaplasia in 52.3%, and carcinoma in situ in 40.7%. The ureters, trigone, and urethra were rarely affected by these lesions. Carcinoma in situ was more commonly associated with multiple carcinomas (68.4%) than with single tumors (32.8%). Squamous metaplasia was found in 81.8% of squamous cell carcinomas and in 16.7% of transitional cell carcinomas. The two cases of adenocarcinoma were associated with columnar metaplasia in the adjacent mucosa. Squamous cell carcinoma and adenocarcinoma probably arise from metaplastic epithelium. Total or subtotal cystectomy is recommended because of the high incidence of carcinoma in situ (40.7%) and multiple carcinomas (22.1%).

Urine cytology is a valuable adjunct but not a substitute for other urologic diagnostic procedures. Cytology offers particular advantage in the detection of pre-clinical cancer and the primary diagnosis of high grade carcinomas. The procedure is of limited value in the diagnosis of benign papilloma and low grade tumors. However, in such cases diagnostic accuracy could be improved by examining bladder irrigation samples, multiple samples, and basing the diagnosis of the identification of papillary clusters rather than individual cellular changes. To ensure comparability of reports in the future there is a great need to standarize several variables, that is the histopathologic classification of tumors, cytologic diagnostic criteria and reporting, as well as the methods adopted to measure validity.

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