To detect human papilloma virus (HPV) infection, p21 oncogene, DNA content of urothelial cells in different bladder lesions with and without schistosomiasis and to correlate them with histopathological grade and stage.

Eighty-five patients were enrolled: 25 chronic cystitis and 60 malignant bladder lesions; 15 schistosomal squamous cell carcinoma (SQCC), 45 urothelial carcinoma (transitional cell carcinoma TCC) schistosomal and non-scistosomal. Ten healthy individuals served as controls. Genotyping of HPV 6/11 and 16/18 were done using in situ hybridization and p21 protein expression by Immunohistochemical technique in formalin-fixed, paraffin-embedded tissues. DNA content of urothelial cells were stained with felugen stains and measured using Automated Image analysis System.

HPV DNA 6/11 and 16/18 expression was increased from cases of schistosomal cystitis with dysplasia to TCC with schistosomiasis compared to TCC and SQCC. The expression increased with statistical significance in invasive TCC and high-grade compared with superficial and low grade. Over-expression of p21 in invasive TCC group was compared with superficial TCC, high-grade TCC was compared low grade and TCC was compared with SQCC. Almost all cases of TCC associated with schistosomiasis exhibit aneuploid histogram compared to SQCC and all invasive TCC exhibited aneuploid histograms.

Both HPV infection and p21 gene abnormalities may contribute to bilharzial bladder carcinogenesis. DNA image cytometric features may predict stage progression in TCC. Expression of p21, DNA HPV 6/11 and 16/18 may be used as biological markers of bladder carcinoma.