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Bladder
Cystitis
Schistosomiasis-related cystitis
Author: Nat Pernick, M.D. (see Authors page)
Revised: 25 December 2009, last major update - December 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Deposition of Schistosoma eggs in bladder causes eosinophilic inflammation, necrosis and ulceration, followed by fibrosis with chronic inflammatory infiltrate
Terminology
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Epidemiology
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● Schistosoma haematobium infection is common in Africa and the Middle East, and is the world's leading cause of hematuria
● Uncommon in US, except in immigrants
Sites
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Etiology
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● Schistosoma larvae (cercariae) are released from snails into water and penetrate human skin exposed to infected water
● Larvae travel to the lungs and liver of the human host, where they reside until they mature
● After maturation, adult worm pairs travel to pelvic veins, where oviposition (egg laying) occurs
● Eggs are deposited in bladder wall vessels and incite a granulomatous response that results in polypoid lesions
● Eggs also incite chronic inflammatory response and fibrosis, a predisposing factor for squamous cell carcinoma
● Eggs are also excreted in urine
● Adult worms may live for many years, and even after their death, large numbers of calcified eggs can be found in bladder wall
Clinical features
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● May clinically simulate urothelial carcinoma
● Complications include hydroureter, hydronephrosis, bladder ulcer, polyposis, bacterial urinary tract infection, renal failure, urothelial carcinoma
● Complications may occur during inactive phase of disease, when diagnosis is most difficult
Prognostic factors
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Case reports
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● 48 year old woman with bladder mass due to S. mansoni (Rev Soc Bras Med Trop 2009;42:581)
Diagnosis
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● S. haematobium eggs are 110-170 x 40-70 microns, oval with terminal spine
Treatment
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Clinical images
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Stalk between bladder
and mass
Schistosoma haematobium - oval eggs with terminal spine
Schistosoma haematobium Fluke
Schistosoma haematobium Eggs
Gross description (Macroscopy)
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Gross images
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Bladder mass
Micro description (Histopathology)
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● Early changes are necrosis and eosinophils with mucosal ulceration
● Late changes are fibrosis with lymphocytes, histiocytes, foreign body granulomas and dystrophic calcification
Micro images
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Eggs in muscularis mucosa with granulomatous response
Egg surrounded by chronic inflammatory cells
Contributed by Drs. Kiran Alam, Anshu Jain, Veena Maheshwari, Farhan A. Siddiqui and Ershadul Haq, J.N. Medical College, India: Schistosoma haematobium
Transitional epithelium of ureter with schistosome eggs in submucosa and muscle
Schistosome eggs in submucosa
Schistosome eggs in muscle layer
Schistosoma mansoni eggs
Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● (link to topic)
Additional references
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● Hum Path 1986;17:333, eMedicine
End of Bladder > Cystitis > Schistosomiasis-related cystitis
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