Unexpected events of ureteric schistosomiasis in Saudi Arabia

common adult cancer. Unlike bladder cancers in the Western countries, that are predominantly transitional-cell carcinoma (TCC), these schistosomiasis-associated bladder cancers are predominantly squamous-cell carcinoma (SCC).[7,8] The histopathological entities of bladder cancer associated with schistosomiasis have certain distinct features that differ from those of bladder cancer found in the Western countries. In many areas of endemic schistosome infection, a much higher proportion SCC of the bladder was seen compared to those occurring in Europe or North America.[8] In Egypt, for example, SCC occurred in 10 of 1000 adults infected with S. haematobium but only in 0 to 3 of 1000 schistosome-free patients.[9,10] The extent of Schistosoma infection apparently plays a significant role in the induction of different types of carcinoma, since SCC is usually associated with moderateand/or high-worm burdens whereas TCC occurs more commonly in areas associated with lower degrees of infection.[11] In other countries also (e.g., Iraq), a strong correlation between S. haematobium infection and SCC is maintained.[12,13] The proportion of SCC varied from 54% to 81% of all bladder cancer cases in different areas of endemic infection, which contrasts to the Western countries, where the frequency of SCC in bladder cancer cases is much lower (3–10%).[13] In general, the major histological cell type of bladder cancer associated with schistosomiasis of the urinary tract is SCC.[14] The new WHO classification of urothelial carcinomas of the urinary bladder (1999) discriminate the minimally invasive papillary urothelial carcinomas in those with infiltration of the lamina propria above the muscularis mucosae (pT1a), the infiltration of the lamina muscularis mucosae (pT1b), and the extension beyond the muscularis mucosae (pT1c). The recurrence rate increases from stage pT1b. This substaging The incidence of schistosomiasis in the Kingdom of Saudi Arabia (KSA) is low; although the presence of ureteric schistosomiasis is low, its presence in association with the other complications is considered a rare event among males, especially in a country like KSA. The objective was to study a 56-year-old Saudi Arabian male, who presented with scistosomiasis in ureter with the development of transitional-cell carcinoma instead of squamous-cell carcinoma. An investigation was carried out in this case by repeated cystoscopes and biopsies for histopathological examinations, as well as several imaging procedures such as plain X-ray, CT, and MRI along with several lab assessments. The presence of all these complications in this patient makes this a case of special interest. This will reflect on conducting further research workup for accurate estimation of schistosomiasis in Saudi Arabia.