title: Impact of density of schistosomal antigen expression in urinary bladder tissue on the stratification, cell type, and staging, and prognosis of carcinoma of the bladder in Egyptian patients.
abstract: BACKGROUND
  Infection with urinary schistosomiasis and its severity are oncogenic factors for developing carcinoma of the bladder, whether it is urothelial carcinoma (UC) of a transitional cell type (TCC) or non-urothelial of squamous cell carcinoma (SCC). In UC it is not defined whether it is schistosomal or not. This led to controversial results in expression of tumour markers, tumour prognosis, and response to therapy.
  
  
  OBJECTIVE
  We assessed the application by immunohistochemistry method (IHC) for detection of schistosomal antigen in bladder cancer tissue samples to differentiate UC associated with or without schistosomiasis. Urothelial carcinoma stage, grade, and progression were correlated with the density, intensity, and index of schistosomal antigen expression. Follow up was done for 2-5 years.
  
  
  METHODS
  Archival tissue samples of 575 patients were studied: 515 urothelial carcinoma, 30 patients with SCC associated with schistosomiasis, and a control group of 30 patients without schistosomiasis.
  
  
  METHODS
  Expression of schistosomal antigen in tissue was done by IHC using monoclonal antibodies (MAbs) against schistosomal antigens (SA). Correlation of intensity of antigen expression to clinical and pathological data was analysed.
  
  
  CONCLUSIONS
  We identified 3 parameters of antigen expression: density, intensity and index with 4 grades for each. SCC-group was 100% positive. UC was positive in 61.4% distributed as follows: Ta: 37.5%, T1: 62%, and muscle invasive T2-4 were 64%. Upstaging, metastases and recurrence were correlated with high index in T1 and T2-4 tumours.
  
  
  CONCLUSIONS
  Urothelial carcinoma associated with schistosomiasis was defined by the positive expression of schistosomal antigens in tissues detected by lHC using MAbs against schistosomal haematobium. Upstaging and progression of T1 and T2-4 were correlated with high density, intensity, and index of antigen expression. Non-schistosomal UC had negative expression for schistosomal antigen, which was detected in 36.5% of cases. These results would be of significance in differentiating schistosomal from non-schistosomal bladder cancer of UC and would predict the prognosis in T1, T2-3 tumours. Implementation of IHC using MAbs against SA in UC would help in planning the proper therapy. Schistosomiasis should be considered as an oncogene for UC in endemic areas.
authors.affiliation: Department of Urology, Theodor Bilharz Research Institute, Kornish El Nil, 12343, Embaba/Giza, P.O.B. 30, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Wishahi
authors.affiliation: Department of Urology, Theodor Bilharz Research Institute, Kornish El Nil, 12343, Embaba/Giza, P.O.B. 30, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zakarya
authors.affiliation: Department of Pathology, Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Olfat
authors.initials: O
authors.lastname: Hamamm
authors.affiliation: Department of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Rasol
authors.affiliation: Department of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Hisham
authors.initials: H
authors.lastname: Badawy
authors.affiliation: Department of Urology, Theodor Bilharz Research Institute, Kornish El Nil, 12343, Embaba/Giza, P.O.B. 30, Cairo, Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Elganzoury
authors.affiliation: Department of Urology, Theodor Bilharz Research Institute, Kornish El Nil, 12343, Embaba/Giza, P.O.B. 30, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ismail
authors.affiliation: Department of Urology, Theodor Bilharz Research Institute, Kornish El Nil, 12343, Embaba/Giza, P.O.B. 30, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Elkhouly
authors.affiliation: Department of Urology, Theodor Bilharz Research Institute, Kornish El Nil, 12343, Embaba/Giza, P.O.B. 30, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Meheina
keywords: Bilharziasis; Cancer prognosis; Endemic diseases; Infection; Monoclonal antibodies; Neglected diseases; Schistosomal antigen; Schistosomiasis; Squamous cell carcinoma; Tumour marker; Urinary bladder; Urothelial carcinoma