Case 150. Bilharziasis of bladder (33 y-o M)
Polypoid urinary bladder lesion surgically resected from an African adult
Key words : Schistosoma haematobium, bilharziasis, cystitis, pseudotubercle
Inside the suppurative granuloma, paired dead flukes containing black pigment in the gut are observed. Inflammation is pronounced in the surrounding tissue (HE, low power). Viable flukes are usually found in the venous lumen.   The dead fluke is heavily infiltrated by neutrophils. The cuticles are well retained, and the gut contains hematin, a residual black pigment after proteolytic digestion of hemoglobin. Epithelioid cell host reaction is demonstrated, and eosinophilic response is mild (HE, higher power).
Numerous large-sized ova containing multinucleated miracidium inside are seen in the bladder wall. Eosinophilic reaction is mild (HE).   Reference case 150A
Schistosomiasis haematobium. Biopsy from the uterine cervix of a Kenyan female (HE). When ulcerative lesions are found in the uterine cervix of subsaharan Africans, we should consider two possibilities: cervical cancer and schistosomiasis.
Reference case 150B
Schistosomiasis haematobium. Surgical specimen of the ureter from a Kenyan male suffering from hydronephrosis (HE). Ureteric lesions showing foreign body reaction (pseudotubercle) against ova may cause hydronephrosis.