الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
157
SUMMARY AND CONCLUSION
Carcinoma of the urinary bladder represents the commonest form of cancer encountered in the Egyptian population. Being associated with schistosomiasis which is an endemic widespread disease in Egypt and occurring at a young age, this form of neoplasia is a major health problem. Using tissue polypeptide antigen as a new tumor marker, this study aimed at better detection, diagnosis and pathological assessment of the disease.
This study included 40 cases of bladder lesions; 50 of them were bilharzial cystitis while the remaining 35 cases constituted the various forms of carcinomas encountered in this organ (18 cases of squamous cell carcinoma, 10 cases of transitional cell carcinoma, 4 cases of adenocarcinoma and 3 cases of undifferentiated carcinoma)
A significant rise in the incidence of transitional cell carcinoma, adenocarcinoma and undifferentiated carcinoma was observed in this study which could be attributed to a multifactorial etiology of the disease in Egypt.
In addition, multiple factors may be involved in the induction of bladder carcinomas in Egypt as evidenced by the similarity in most of the urothelial abnormalities in both the bilharzial and non-bilharzial groups of the disease.
The intensity of lymphocytic infiltration in the lamina propria was found to correlate with the presence of abnormal epithelial structures (i.e. cystitis glandularis, cystitis cystica and Brunn’s nests) rather than oviposition. Also it was found to be directly proportionate to the tumor grade in squamous cell carcinoma and transitional cell carcinoma while this relation was reversed in association with adenocarcinoma.
Summary and Conclusion 158
The mean age of bladder carcinomas was found to be higher than those previously mentioned in early reports. This could be an indicator of the success of the public health program concerning bilharzial control.
TPA localization was investigated in 35 cases of urinary bladder carcinomas both bilharzial and non-bilharzial.
Our observation of the existence of unstained cells for TPA in the urothelium adjacent to malignant tumor area could be taken as an indicator of the presence of malignant tumor since TPA was found in all cells of the urothelium overlying non-tumorous bladders.
In addition, a totally negative TPA staining in the basal layer of hyperplastic transitional epithelium accompanying transitional cell carcinoma may indicate non-squamous cell undifferentiated carcinoma.
Distribution of TPA staining reaction could be useful in tumor grading as no isolated stained cells could be observed in low grades of squamous cell carcinoma and transitional cell carcinoma, while in the higher grades isolated stained cells started to appear. Also the percentage and staining intensity of TPA reactive cells decreased with the increase in the tumor grade in both types of the tumor.
In undifferentiated carcinoma, a DROP in the percentage of stained cells was observed more than the highest grades of both squamous cell carcinoma and transitional cell carcinoma.
Summary and Conclusion 159
Similarly, TPA distribution could also • help in grading of adenocarcinoma, since it was located in the basal parts of the acini in grade I while in grade II it was diffusely present all over the cytoplasm.