Background: Urinary bilharziasis represent a major health problem in Egypt. It is charactrarized by the formation of localized collection of immune cells i.e. granulomas. In this investigation, we hypothesized that the evolution of the bilharzial granuloma is associated with recruitment of immune cells of diverse cell lineage. To explore this hypothesis and to fill this existing gap in the literature, we carried out this investigaiton. Materials and Methods: Granuloma cell population was immunohistologically examined in thirty cases of cellular bilharzial granulomas using immunoperoxidase staining methods and antibodies targeting antigens for B cells (CD20+), T cells (CD3+), histiocytes (CD68+) and cytotoxic T cells (Granzyme B). Results: The mean values of positive cells in the cellular bilharzial granulomas were: 45.5±5.6 for CD68+ cells; 14.8±1.1 for CD3+ T cells; 9.1±1.1; for CD20+ B cells and 1.5±0.8; for Granzyme B + T cells with cytotoxic activity. Conclusions: The numerical dominance of CD68+cells suggests their critical role in the evolution of these lesions. Our study was the first to report immunophenotypic profile of the bilharzial grnaulomas