الفهرس 
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Abstract
Summary
Urinary bladder carcinoma represents the ninth most common cause of cancer worldwide and the thirteenth most common cause of cancer deaths. Over 90% of cases of urinary bladder carcinoma are urothelial carcinomas. The exact etiology of bladder cancer is still unknown but several risk factors have been reported as being involved in its pathogenesis such as cigarette smoking, synthetic nitrogen fertilizers, organophosphate based pesticides, pelvic irradiation, cyclophosphamide, chronic cystitis, schistosomiasis, human papilloma virus, genetic predisposition and some occupations such as working in dye industry. The relative importance of such risk factors in the pathogenesis of the disease differs in different populations.
CD44 is a ubiquitous multistructural and multifunctional cell surface adhesion molecule first identified in lymphocytes. It is involved in cell-cell and cell-matrix interactions also involved in cell proliferation, differentiation, migration, angiogenesis, presentation of cytokines, chemokines, and growth factors to the corresponding receptors, and docking of proteases at the cell membrane, as well as in signaling for cell survival. All these biological properties are essential to the physiological activities of normal cells, but they are also associated with the pathologic activities of cancer cells.
The present study was conducted on 40 cases of previously diagnosed urothelial bladder carcinoma obtained from the Pathology Department, Faculty of Medicine, Beni-Suef University, during the period from May 2017 to May 2018. The paraffin blocks were recut at 5 microns thickness and stained with Hematoxylin & Eosin and CD44 monoclonal antibody. The studied cases were predominantly males (80%) with male to female ratio 4:1. The age incidence ranged from 35 years to 80 years with a mean age of 61.40 ±10.7 years and peak incidence among the age group above 60 years old. Twenty eight cases (70%) of the studied tumors were ≥ 3 cm in diameter while 30% of the cases were < 3 cm.
Regarding tumor grade, the majority of the studied tumors (82.5%) were high grade while 17.5% were low grade. In this study, conventional invasive urothelial type was the most frequent histological type representing (44.4%) of the total studied cases followed by squamous differentiation (29.4%), glandular differentiation (14.8%), micropapillary differentiation (3.7%) and small cell differentiation(7.4%), while all non muscle invasive tumors (32.5%) were papillary variants. According to the depth of invasion (T stage), 67.5% of the studied cases showed muscle invasion arranged as following: pT3 represented 30% of the cases, pT2 (25%), pTa (17.5%), pT1 (15%) and pT4 represented 12.5% of the total studied cases. Lymph node metastases were detected in thirteen cases (48%). Moreover, schistosomal ova were detected in 42.5% of studied cases. Only three cases (7.5%) showed vascular invasion in the examined specimens. Also, there was perineural invasion in 17.5% of the studied cases.
In our current study, 75% of the studied cases showed positive CD44 expression. A statistically significant relationship was detected between CD44 expression and tumor grade (P value= 0.002) and pathological T stage (P value= 0.041).Also, there was significant inverse correlation between CD44expression and (tumor grade &stage). The relation between CD44expression and other clinicopathological parameters such as age, sex, tumor size, lymph node status, bilharzial infestation and perineural invasion was statistically insignificant.