Bilharzial-associated Squamous Cell Carcinoma of the Bladder in Pregnancy: A Case Report

Abstract

Squamous cell carcinoma (SCC) of the bladder is a rare and devastating malignancy, usually associated with Schistosoma haematobium, particularly in bilharzia-endemic regions of sub-Saharan Africa. Little is written about the condition in pregnancy. A 21-year-old Gravida 2 Para 1 at 28 weeks gestation presented with worsening symptoms of dysuria, increased frequency of micturition, backache, a painful suprapubic mass and haematuria over a period of 3 weeks. On examination, vital signs were normal, the height of fundus was 26cm, with a tender suprapubic mass. Extraperitoneal laparotomy revealed multiple signs of a bladder malignancy which were confirmed by histopathology as Schistosoma haematobium ova and invasive keratinising SCC of the bladder, grade 1. Intraoperatively, T4 carcinoma staging was confirmed. The patient was delivered prematurely by caesarean section due to worsening symptoms. Palliative care was instituted as the functional status of the patient did not allow for definitive management. Subclinical urinary schistosomiasis can progress to a SCC of the bladder, presenting with symptoms implicated in conditions such as bladder lithiasis, Urinary tract infections and pregnancy. Urine cytology and mass drug administration should be enforced as means of early detection and prevention, respectively in endemic regions.