الفهرس 
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Abstract
In the current study, fifty cases of UBC (divided as: 30 TCC cases, 15 SCC cases and 5 adenocarcinoma cases) were randomly collected from the Pathology departments, Faculty of Medicine, Cairo University, Kasr El Aini Hospital and Beni-Suef University during the period (October, 2017 till March, 2018). where 39 cases had undergone radical cystectomy procedure and 11 cases had undergone cystoscopic biopsy procedure (2 of which infiltrates muscularis propia, 5 did not infitlrate and in the rest (4 cases) of the biopsies muscularis propria was not available), we found the mean age of our cases was 60.14 years and most of them (30 (60%) cases) were in age group (>50-60y). Among the studied cases male predominance (41 (82%) cases) was noticed. Regarding the 39 radical cystectomy cases the majority of the studied tumors (19 (49%) cases) were found in or near lateral wall of urinary bladder. All 39 radical cystectomy cases tumors in the present study were solitary, ranging in size from (2 to 12 cm) with average size 4.88 cm. Eleven cases (28.2%) showed tumor size less than or equal to 3 cm in maximum diameter, while 28 (71.8%) had tumor size more than 3 cm.
Most of tumors 24 (61.5%) in the 39 studied radical cystectomy cases were described as fungating tumor while the tumors in 12(30.8%) cases were ulcerated and 3 (7.7%) cases showed infiltrating tumor. Out of fifty patients, 30 (60%) cases showed negative bilharzial infestation while those with positive bilharzial infestation were 20 (40%) cases.
Grading of the 50 studied cases were assessed according to the WHO grading system of UBC (2004) revealed that low grade was reported in one (2%) case while those of high grade were 49 (98%) cases. Assessment of the pathological (pT) stage of the 46 studied cases (39 radical cystectomy cases + 7 cystoscopic biopsy cases) of UBC according to the TNM classification of carcinomas of urinary bladder (2010). revealed that most of the tumors invades the perivesical tissue (T3&T4). While assessment of the pathological (pN) stage of 39 studied radical cystectomy cases revealed that most of the tumors 26 (66.7%) showed pN0.
The total 50 primary UBC cases included in this study were evaluated by immunohistochemistry, using monoclonal antibodies against Survivin. It was noticed that expression of Survivin was seen in 47 (94%) cases, while 3 (6%) cases were negative. Whereas 3 (6%) cases with immunoreactive score (IRS) negative, 12 (24%) cases with IRS mild, 16 (32 %) cases with IRS moderate, 19 (38%) cases with IRS intense.
from the results of this thesis it was found that Survivin expression in Fungating UBC cases was statistically significant when compared with Ulcerating and Infiltrating UBC cases (p<0.045). Detection of Survivin immunostaining was not statistically significant in different pathological (pT) stage of studied cases, although 82.6% of cases showed muscle invasion were positive for Survivin. So, there was a significant positive relationship between the intensity of Survivin and pathological (pT) stage of tumor i.e., as most of Survivin expression cases was found in advanced pathological (pT) stage.
The detection of Survivin immunostaining in cases with no lymph node metastasis (pathological (pN0) stage) was statistically significant when compared with cases with lymph node metastasis, where a tendency for Survivin positivity to predominate in less advanced pathological (pN0) stage of tumors (p<0.050).
There was no correlation between Survivin expression and different clinicopathological parameters such as age, sex, grade, site, size, bilharzial infestation and different histological types of UBC of the studied cases.
These findings may have clinical implications for the management of patients with Survivin-positive UBC and Survivin status would be helpful in formulating a treatment strategy for patients with UBC.