الفهرس 
Normal AnatomyOnly 14 pages are availabe for public view
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Abstract
The urinary bladder carcinoma (UBC) accounts for about 3.2% of all cancers worldwide (Parkin et al., 1999) while it represents 12% and 9.5% of the malignant cases according to the latest registry of Egyptian National Cancer Institute and Gharbia Cancer Registry respectively (Mokhtar et al., 2007). Moreover, the incidence of UBC cases was higher in Egypt when compared to some Middle East countries and United States. (Freedman et al., 2006). In industrialized Western countries, 90%-95% of UBC are urothelial carcinoma (UC); 3%-7% are squamous cell carcinoma (SCC), and 1%- 2% are adenocarcinomas (ADC) (Sengupta et al., 2004). In Egypt SCC showed the highest incidence of UBC in the eighties but it was exceeded by UC later on (Gouda et al., 2007). This study was carried out on 50 cases of urinary bladder carcinoma (UBC) and 15 cases of normal bladder biopsies taken from bladder wall during TURP. The age of normal cases ranged from 46 and 71 years old with mean ± SD of 60.10 ± 2.1. The age of the UBC patients ranged between 24 and 85 years old with mean ± SD of 62.69 ± 1.1 and median of 63. Most of the cases were male (46/50, 92%). The tumor presented in 52% of the cases as mass (26/50,), the rest (48%) was presented as ulcer (24/50,). The mean tumor size was 5.6±2 cm ranged between 2 and 12 cm. The tumor was in the dome of the bladder in 8% (4 cases) and in other sites in the bladder in 92% (46 cases).Urothelial carcinoma (UC) represented 50% of our cases (25 cases), squamous cell carcinoma (SCC) 42% (21 cases) and adenocarcinoma (ADC) 8% (4 cases). The grade was high in most of the cases (92%) (divided into 46% grade 2 and 48% grade 3) and only 3 cases showed low grade (6%). SCC insitu was found in association to 4 cases of SCC and flat urothelial carcinoma insitu was found in association to 2 cases of UC. The apoptotic index ranged between 10 and 40 with mean ± SD of 22.6 ± 7.6. The median of apoptotic index was 24.5. The mitotic index ranged between 8 and 46 with mean ± SD of (26.2±11). The median of mitotic index was 25. Lymph nodes showed metastatic deposits in only 20% of cases. Only one case showed limited tumor to the subepithelium (pT1). Cases that showed invasion to muscles (pT2) comprised 15 cases (30%), those showed invasion to extra-vesical tissue (pT3) comprised 25 cases (50%) and cases with extension to adjacent structures (pT4) were 9 cases (18%) In most of the cases, there was no peri-vascular invasion (47 cases, 94%) or peri-neural invasion (48 cases, 96%). 23 cases (46%) showed schistosomiasis infestation. UC and ADC showed higher mean age when compared to SCC. Most of the female cases (3/4, 75%) presented as SCC. The UC and SCC cases showed significantly higher mean tumor size when compared to ADC group (U= 2.48 p= 0.016) [data not shown]. Mass and ulcer gross pathology were represented nearly equally in UC and ADC. SCC showed a mass lesion in 12/21 cases. Most of the lesions presented at the dome were diagnosed as squamous cell carcinoma (75%). Comparing UC and SCC, there was no significant difference between both groups regarding most of clinicopathologic features. The mean tumor size was slightly larger in UC than in SCC with statistically near significant difference (p=0.058). Also, SCC showed higher apoptotic and mitotic indices. Most of lymph node positive cases were transitional cell carcinoma (80%). In control cases tenascin-c was not observed in the normal urothelium. In contrast, tenascin-c expression was observed in malignant cells in 29 cases of total malignant cases representing 59%. UC cases constituted most of the positive cases (66%) when compared to SCC and ADC cases p= 0.001. In the same context, the mean H score for tenascin-c expression for all cases ranged from 0 to 280 with a mean ± SD of 72.80 ± 89.26. There was a significant difference as regards expression in malignant cells in different histological types. SCC showed condensation of staining in the periphery of cell nests that resulted in lower H score values as compared to UC and ADC cases (P= 0.000 and 0.016 respectively). However there was no significant difference between UC and ADC (P=1.000). In situ carcinoma was observed in association to 6 cases (4 SCC and 2 UC). TN-C positivity was seen in 4 cases (2SCC and 2 UC). The stroma showed tenascin-c expression in 14 cases (28%). There was no significant difference regarding number of cases with positive stroma for tenascin-c among variable histological types p= 0.332. There was a significant association between positive tenascin-c staining in malignant cells and higher pathological T stage (P=0.016). Similarly, higher H score of TN-C was associated with lymph node metastasis(0.0001) and higher pathological T stage (0.0001). However, there was no significant relationship between tenascin-c positivity in malignant cells and other clinicopathologic features.