Schistosomiasis then and now: what has changed in the last 100 years?

Only with the completion of the life cycles of Fasciola hepatica in 1883 and 30 years later those of Schistosoma japonicum (1913), Schistosoma haematobium and Schistosoma mansoni (1915) did research on schistosomiasis really get underway. One of the first papers by Cawston in 1918, describing attempts to establish the means of transmission of S. haematobium in Natal, South Africa, forms the historical perspective against which to judge where we are now. Molecular biology techniques have produced a much better definition of the complexity of the schistosome species and their snail hosts, but also revealed the extent of hybridization between human and animal schistosomes that may impact on parasite adaptability. While diagnostics have greatly improved, the ability to detect single worm pair infections routinely, still falls short of its goal. The introduction of praziquantel ~1982 has revolutionized the treatment of infected individuals and led directly to the mass drug administration programmes. In turn, the severe pathological consequences of high worm burdens have been minimized, and for S. haematobium infections the incidence of associated squamous cell carcinoma has been reduced. In comparison, the development of effective vaccines has yet to come to fruition. The elimination of schistosomiasis japonica from Japan shows what is possible, using multiple lines of approach, but the clear and present danger is that the whole edifice of schistosome control is balanced on the monotherapy of praziquantel, and the development of drug resistance could topple that.

Iodine-125 seeds in prostatic transurethral resection: Differential diagnosis with schistosome eggs.

The presence of foreign bodies in a prostate transurethral resection may pose a histopathological challenge. A 65-year-old white man with urinary obstructive symptoms was subjected to a transurethral resection. Histopathology showed a squamous cell carcinoma affecting prostatic ducts and multiple foreign bodies; their differential diagnosis was between iodine-125 seeds and Schistosoma sp. eggs, as both can show oval morphology and terminal spines. The seeds are irregular, homogeneous and solid, unlike Schistosoma eggs that are heterogeneous, with a lytic appearance and some embryonated or calcified. The seeds are located in prostatic ducts inducing periductal fibrosis whereas the Schistosoma sp. eggs are found in the stroma inducing desmoplasia and granulomas. The seeds are associated with a lymphoplasmacytic infiltrate while the eggs are surrounded by eosinophils.

Genital Lichen Sclerosus Et Atrophicus: A Benign Skin Disorder With Malignant Aftermath.

Genital lichen sclerosus et atrophicus (LSA) is an uncommon genital dermatosis. Its resemblance to vitiligo, especially during the earlier stages, leads to delay in its diagnosis. Apart from the common complications such as meatal stenosis, balanoposthitis, phimosis, and painful erections, squamous cell carcinoma is a rare but ominous complication of genital LSA. Herein, we present a case of long-standing penile LSA complicated by squamous cell carcinoma, stressing upon the requirement of early diagnosis and management of LSA.

Myiasis associated with penile carcinoma: a new trend in developing countries?

ABSTRACT Objectives The aim of this study is to report an unusual form of penile cancer presentation associated with myiasis infestation, treatment options and outcomes. Materials and Methods We studied 10 patients with suspected malignant neoplasm of the penis associated with genital myiasis infestation. Diagnostic assessment was conducted through clinical history, physical examination, penile biopsy, larvae identification and computerized tomography scan of the chest, abdomen and pelvis. Clinical and pathological staging was done according to 2002 TNM classification system. Radical inguinal lymphadenectomy was conducted according to the primary penile tumor pathology and clinical lymph nodes status. Results Patients age ranged from 41 to 77 years (mean=62.4). All patients presented squamous cell carcinoma of the penis in association with myiasis infestation caused by Psychoda albipennis. Tumor size ranged from 4cm to 12cm (mean=5.3). Circumcision was conducted in 1 (10%) patient, while penile partial penectomy was performed in 5 (50%). Total penectomy was conducted in 2 (20%) patients, while emasculation was the treatment option for 2 (20%). All patients underwent radical inguinal lymphadenectomy. Prophylactic lymphadenectomy was performed on 3 (30%) patients, therapeutic on 5 (50%), and palliative lymphadenectomy on 2 (20%) patients. Time elapsed from primary tumor treatment to radical inguinal lymphadenectomy was 2 to 6 weeks. The mean follow-up was 34.3 months. Conclusion The occurrence of myiasis in the genitalia is more common in patients with precarious hygienic practices and low socio-economic level. The treatment option varied according to the primary tumor presentation and clinical lymph node status.

Myiasis associated with penile carcinoma: a new trend in developing countries?

OBJECTIVES: The aim of this study is to report an unusual form of penile cancer presentation associated with myiasis infestation, treatment options and outcomes. MATERIALS AND METHODS: We studied 10 patients with suspected malignant neoplasm of the penis associated with genital myiasis infestation. Diagnostic assessment was conducted through clinical history, physical examination, penile biopsy, larvae identification and computerized tomography scan of the chest, abdomen and pelvis. Clinical and pathological staging was done according to 2002 TNM classification system. Radical inguinal lymphadenectomy was conducted according to the primary penile tumor pathology and clinical lymph nodes status. RESULTS: Patients age ranged from 41 to 77 years (mean=62.4). All patients presented squamous cell carcinoma of the penis in association with myiasis infestation caused by Psychoda albipennis. Tumor size ranged from 4cm to 12cm (mean=5.3). Circumcision was conducted in 1 (10%) patient, while penile partial penectomy was performed in 5 (50%). Total penectomy was conducted in 2 (20%) patients, while emasculation was the treatment option for 2 (20%). All patients underwent radical inguinal lymphadenectomy. Prophylactic lymphadenectomy was performed on 3 (30%) patients, therapeutic on 5 (50%), and palliative lymphadenectomy on 2 (20%) patients. Time elapsed from primary tumor treatment to radical inguinal lymphadenectomy was 2 to 6 weeks. The mean follow-up was 34.3 months. CONCLUSION: The occurrence of myiasis in the genitalia is more common in patients with precarious hygienic practices and low socio-economic level. The treatment option varied according to the primary tumor presentation and clinical lymph node status.

p70S6K promotes IL-6-induced epithelial-mesenchymal transition and metastasis of head and neck squamous cell carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is the fifth most common cancer worldwide and a common cause of cancer-related death, with a 5-year survival rate of less than 60%. IL-6 has been suggested to play an important role in cancer metastasis, but its mechanism in HNSCC has not been fully clarified. p70S6K has been reported to induce epithelial-mesenchymal transition (EMT) of ovarian cancer, but its role in HNSCC remains unknown. In this study, we found that p70S6K and IL-6 were upregulated in high-metastatic HNSCC cell lines that underwent EMT when compared to paired low-metastatic cell lines. Overexpression of p70S6K promoted EMT and migration of HNSCC cells, while downregulation of p70S6K attenuated IL-6-induced EMT and cell migration. Furthermore, IL-6-induced p70S6K activation was attenuated by inhibitors of the PI3K/Akt/mTOR, MAPK/ERK, and JAK/STAT3 signaling pathways, suggesting that it located downstream of these pathways. These findings suggest that p70S6K promotes IL-6-induced EMT and metastasis of HNSCC. Targeting p70S6K for HNSCC therapy may benefit patients through the inhibition of tumor growth, as well as metastasis.

Lymph node metastasis in clinical stage IA peripheral lung cancer.

OBJECTIVES: To investigate lymph node metastasis especially the intrapulmonary node in clinical IA peripheral lung cancer patients to evaluate the indications for lung segmentectomy in lymph node level. MATERIALS AND METHODS: Patients (n=292) with clinical stage IA peripheral lung cancer received radical lobectomy at our department between October 2013 and July 2014 were enrolled in our study. Lymph nodes were obtained during routine surgical procedures while segmental lymph nodes were dissected from the resected lobe for pathological examination. New classification for pulmonary adenocarcinoma with each histologic component was also analyzed. RESULTS: The percentage of patients found to have no lymph node metastasis was 90.4% (264/292). Tumor size on computed tomography and tumor consistency were independent predictors for lymph node metastasis. Tumor with a dominant ground-glass opacity (GGO) component was a good predictor for lymph node metastasis (p<0.001). Metastasis was more common in larger tumors (p<0.001), but there was non-tumor bearing segment metastasis even in tumor less than 1cm. Patients with micropapillary or solid component were correlated with lymph node metastasis (p=0.001 and p=0.009, respectively). CONCLUSIONS: The rate of metastasis to the lymph nodes is very low in clinical stage IA peripheral lung cancer patients. Patients with a dominant GGO component on CT might be the suitable candidates for lung segmentectomy because of almost no lymph node metastasis. Careful selection should be made for the patients with tumor size ≤2 cm who had metastasized nodes in non-tumor bearing segment when considering segmentectomy. If the resected tumor had micropapillary or solid component, the lobectomy might be considered.

Myiasis Associated with Oral Squamous Cell Carcinoma--A Literature Review.

Advanced oral squamous cell carcinoma (SCC) is a possible risk factor for myiasis, a parasitic infestation of vital tissue of humans or other mammals by dipterous larvae (maggots). Oral myiasis is a rare entity, and is mostly associated with various medical and anatomical conditions, such as neglected mandibular fracture, lip incompetence, cerebral palsy, poor oral hygiene, suppurative lesions, and cancerous wounds. Larvae cause itching and irritation due to their crawling movements and can destroy vital tissues, inducing serious or even life-threating hemorrhage. The aim of the present article was to highlight the occurrence of oral myiasis in association with squamous cell carcinoma and also to highlight the treatment and preventive approaches for such cases. A literature search was performed using MEDLINE for articles published in English relating to the occurrence of oral myiasis in oral SCC. Our search revealed 6 reports on myiasis associated with oral SCC. The surgical debridement of infected tissue with the removal of maggots is the treatment of choice in most cases of oral myiasis.

[Histological aspect of urinary schistosomiasis in Togo: results of a cohort of 192 cases]. / Aspect histologique des séquelles de la bilharziose urinaire au Togo: résultats d'une série de 192 cas.

The high prevalence of urinary schistosomiasis in Togo and its late management often lead to sequels. This study takes stock of these cancerous and non-cancerous lesions observed on histological pieces in the pathology laboratory of the Teaching Hospital of Lome in 10 years. We find 28.1 % of malignant tumor lesions, dominated by urothelial carcinoma.

Massive myiasis in an advanced metastatic neck tumor.

Only a small number of cases of myiasis have been previously reported in patients with a head and neck malignancy; most of these occurred in patients with primary or metastatic skin cancer. We report a case of massive Lucilia sericata myiasis in the neck of a 57-year-old man with primary squamous cell carcinoma of the larynx and hypopharynx that metastasized to the neck lymph nodes. The neck disease manifested as necrosis and skin involvement. Clinical examination revealed an extensive wound within the neck tumor at levels II and V on the right that was heavily infested with maggot larvae. Removal of larvae clusters was performed, and the isolated larvae were subsequently identified as L sericata. To the best of our knowledge, this is the first report of an infestation of L sericata myiasis in a metastasis to the neck lymph nodes.

Estrogen-like metabolites and DNA-adducts in urogenital schistosomiasis-associated bladder cancer.

An estrogen-DNA adduct mediated pathway may be involved in the pathogenesis of the squamous cell carcinoma of the bladder associated with infection with the blood fluke Schistosoma haematobium. Extracts from developmental stages of S. haematobium, including eggs, induce tumor-like phenotypes in cultured cells. In addition, estrogen-derived, reactive metabolites occur in this pathogen and in sera of infected persons. Liquid chromatography-mass spectrometry analysis was performed on urine from 40 Angolans diagnosed with urogenital schistosomiasis (UGS), half of who also presented UGS-associated squamous cell carcinoma and/or urothelial cell carcinoma. The analysis revealed numerous estrogen-like metabolites, including seven specifically identified in UGS cases, but not reported in the database of metabolites in urine of healthy humans. These schistosome infection-associated metabolites included catechol estrogen quinones (CEQ) and CEQ-DNA-adducts, two of which had been identified previously in S. haematobium. In addition, novel metabolites derived directly from 8-oxo-7, 8-dihydro-2'-deoxyguanosine (8-oxodG) were identified in urine of all 40 cases of UGS. These metabolites can be expected to provide deeper insights into the carcinogenesis UGS-induced bladder cancer, and as biomarkers for diagnosis and/or prognosis of this neglected tropical disease-linked cancer.

Myiasis on squamous cell carcinoma of skin.

Advanced squamous cell carcinoma (SCC) is a challenge for treatment. It is also a risk factor for unintended infestation with diptera larvae (maggots) known as myiasis. We performed a retrospective investigation in our files from 2001 to 2014 and identified three patients with SCC-associated myiasis (three men). In all three cases, Lucilia spp. were found. A literature review using PUBMED revealed another 12 cases of SCC-associated myiasis due to different species. It is not only a disease of older age, as two of the patients were in their 20s. The male to female ratio was 2 to 1. Wound myiasis and cavity myiasis were seen in half of the cases each. Pain, bleeding, and infection were possible symptoms due to infestation but not all patients reported complaints. Treatment aims to completely remove all maggots and to prevent secondary tissue damage with blindness due to eye ball destruction as one of the worst.

Assessment of the new nodal classification for cutaneous squamous cell carcinoma and its effect on patient stratification.

BACKGROUND: The American Joint Committee on Cancer (AJCC) substantially changed the staging of cutaneous squamous cell carcinoma (SCC) in the seventh edition of its staging manual. Although the system is well established in mucosal SCC, very little data are available on its prognostic value in cutaneous SCC. METHODS: We conducted a multivariable analysis of 672 patients with metastatic cutaneous SCC from 2 prospective cancer center databases. RESULTS: The differentiation between N1 and N2 subgroups demonstrate little prognostic importance in cutaneous SCC, whereas survival is significantly worse for N3. CONCLUSION: Although the introduction of a unified N system for mucosal SCC and cutaneous SCC has added complexity, it does not translate into optimal distribution and stratification for metastatic cutaneous SCC.

c-KIT positive schistosomal urinary bladder carcinoma are frequent but lack KIT gene mutations.

Urinary bladder squamous cell carcinoma (SCC), one of the most common neoplasms in Egypt, is attributed to chronic urinary infection with Schistosoma haematobium (Schistosomiasis). The proto-oncogene c-KIT, encoding a tyrosine kinase receptor and implicated in the development of a number of human malignancies, has not been studied so far in schistosomal urinary bladder SCCs. We therefore determined immunohistochemical (IHC) expression of c-KIT in paraffin sections from 120 radical cystectomies of SCCs originally obtained from the Pathology Department of Suez Canal University (Ismailia, Egypt). Each slide was evaluated for staining intensity where the staining extent of >10% of cells was considered positive. c-KIT overexpression was detected in 78.3% (94/120) of the patients, the staining extents in the tumor cells were 11-50% and >50% in 40 (42.6%) and 54 (57.4%) respectively. The positive cases had 14.9%, 63.8%, 21.3% as weak, moderate and strong intensity respectively. Patients with positive bilharzial ova had significantly higher c-KIT expression than patients without (95.2% vs. 38.9%, P=0.000). Mutation analysis of exons 9-13 was negative in thirty KIT positive cases. The high rate of positivity in SBSCC was one of the striking findings; However, CD117 may be a potential target for site specific immunotherapy to improve the outcome of this tumor.

Visceral leishmaniasis revealed by a squamous cell carcinoma in an HIV-1 infected patient.

We present a case of visceral leishmaniasis confirmed after the histological investigation of an ulcerate lesion of the scalp in an HIV-1-infected patient receiving highly active antiretroviral therapy (HAART). Histological examination of the skin lesion revealed a squamous cell carcinoma superinfected by amastigotes of Leishmania infantum from the bloodstream. Because HIV-1-infected individuals can harbour parasitic infections in normal and neoplastic tissue, it is necessary to examine carefully any skin lesions, particularly those with uncommon aspects or a worsening course, to exclude superinfections by unsuspected pathogens.

TGF-B1 pathway as biological marker of bladder carcinoma schistosomal and non-schistosomal.

OBJECTIVES: Study TGF-ß1 pathway in bladder carcinoma. DESIGN AND METHODS: Eighty-one patients were enrolled: 16 chronic cystitis and 60 malignant bladder lesions; 15 schistosomal squamous cell carcinoma (SQCC), 45 transitional cell carcinoma (TCC). Five healthy individuals served as controls. mTGF-ß1, protein, and its receptor expression in urine and bladder tissue were measured using in situ hybridization and immunohistochemical techniques, respectively. RESULTS: Overexpression of TGF-mRNA in invasive TCC group was compared with superficial TCC, high grade TCC was compared with low grade, and SQCC was compared with TCC. TGF-ß1 protein and its receptor I (TGF-ßR1) were overexpressed in urine samples in malignant group compared with chronic cystitis and in SQCC group compared with TCC group. TGF-ß1 protein and its receptor were significantly increased in schistosomal malignant group compared with non-schistosomal group. CONCLUSION: Expression of TGF-ß1 and TGF-ßR1 could be used as biological markers of bladder carcinoma.

Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: differential diagnostic value in cervical lymphadenopathy.

AIM: To evaluate whether the analysis of the apparent diffusion coefficient (ADC) values of the necrotic and solid portions of lymph nodes aids differentiation between the causes of cervical lymphadenopathy. MATERIALS AND METHODS: Thirty-six patients with cervical lymph node metastasis from head and neck squamous cell carcinomas (SCC), 19 patients with lymphoma, and 23 patients with tuberculous lymphadenitis underwent conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI). The ADC values of necrotic and solid portions of lymph nodes were measured and compared. Receiver operating characteristic (ROC) analysis was employed to investigate whether ADC values could help to discriminate between the causes of cervical lymphadenopathy, and to obtain the optimal ADC threshold values. RESULTS: The mean ADC values of the solid portions of metastatic nodes, lymphomatous nodes, and tuberculous nodes were (0.93±0.16)×10(-3)mm(2)/s, (0.64±0.13)×10(-3)mm(2)/s and (1.01±0.11)×10(-3)mm(2)/s, respectively (p<0.01). The mean ADC values of necrosis of metastatic and tuberculous nodes were (2.02±0.36)×10(-3)mm(2)/s and (1.25±0.15)×10(-3)mm(2)/s (p<0.01). By using the ADC value of the solid portion, the optimal ADC threshold values for distinguishing between metastasis and lymphoma, between metastasis and tuberculosis, and between lymphoma and tuberculosis were 0.77×10(-3), 0.98×10(-3) and 0.81×10(-3)mm(2)/s, respectively, and the sensitivities and specificities were 83 and 89%, 70 and 68%, 93 and 100%, respectively. By using ADC values of necrosis, the optimal ADC threshold value for distinguishing between metastasis and tuberculosis was 1.59×10(-3)mm(2)/s, and the sensitivity and specificity were 88 and 100%, respectively. CONCLUSION: The ADC values both of the necrotic and solid portions of the lymph nodes are useful in differentiation between the causes of cervical lymphadenopathy. The ADC value of necrosis is especially helpful in discriminating metastasis from tuberculosis.

Haematobium eggs detection in human bladder cancer and sporocysts in snail vectors: Seven cases report and a review of the Burkina Faso literature.

Schistosoma haematobium plays a central role in the development of bladder cancer in Burkina Faso. The objective of this study was to determine the presence of S. haematobium in the bladder cancer and in vector snails. For the first time, formalin-fixed tissues embedded in paraffin were analyzed by immunohistochemistry and PCR. Molecular detection has resulted in 7/7 positive bladder cancer. Finally, as the snail vectors were positive. We suggest the use of molecular methods in the snail vectors for the detection of cysts and in cancerous tissues in larger studies.