Primary nonurachal adenocarcinoma in the bilharzial urinary bladder: deoxyribonucleic acid flow cytometric and morphologic characterization in 93 cases.

OBJECTIVES

To characterize adenocarcinomas of the urinary bladder by their DNA profiles and their proliferative properties.

METHODS

Primary nonurachal adenocarcinomas, found in 93 patients with bilharzial bladder carcinomas, were studied using DNA flow cytometry. Tumor ploidy and S-phase fraction were related to tumor grade, stage, cell type, and lymph node status.

RESULTS

Aneuploidy with high S-phase fractions, found in 90% of the tumors, demonstrates the high malignancy potential of these tumors, the majority of which were found to be muscle-infiltrative. There were no relationships between ploidy or S-phase fraction and tumor grade and stage. Lymph node metastases, present in 24% of the 93 patients, were found exclusively in nontetraploid aneuploid tumors with high S-phase fractions exceeding 100%. Paraffin-embedded tissues compared with fresh material gave the same information on ploidy, whereas bladder washing did not provide adequate information.

CONCLUSIONS

The high aggressiveness of adenocarcinomas in the biharzial bladder is confirmed and can be explained by their proneness to develop gross chromosomal aberrations combined with high cell proliferation.