transitional cell carcinoma

Genito-Urinary Tumors

Episode 6

Transitional Cell Carcinoma

• Primary neoplasms of the renal collecting

system represent 10% of the renal tumors, of

which approximately 80% are malignant. Most

are transitional cell carcinomas (TCCs).


• Bladder TCC is 50 times more common than

renal pelvic tumors. Often, TCCs are multiple,

involving any part or all of the collecting system.


•The male-to-female ratio is 3-4:1

•50-70 years.


Causative agents:

Exposure to a large variety of chemical carcinogens:

1. Tobacco.2. Aniline dyes.3. Benzidine.4. Aromatic amines. 5. Abuse of analgesics.6. Cyclophosphamide therapy, particularly after drug-

induced hemorrhagic cystitis.7. Recurrent or chronic infection and urinary calculi. Renal pelvic papillomas.


Causative agents:

• Chemical carcinogens act locally on the epithelium

causing chronic irritation → Hyperplastic Metaplastic

changes.

• Their action is enhanced by the contact time.

• Partial obstruction may account for increased exposure to

the upper tracts.


Pathology:

Broad classification:

(1) Exophytic papillary lesion (85%).

(2) Non-papillary, non-infiltrating.

(3) Infiltrating.

(4) Carcinoma in situ.


Pathology:

Spread:

1. Direct extension into the retroperitoneum.

2. Hematogenous.

3. Lymphatic.


Pathology:

Spread:

Metastases from ureteral TCC are far more common

than those from bladder cancer partly because the

ureteral wall is thin and acts as a poor barrier.


Hematuria.

• For upper tract TCC pain, abdominal mass

and pyuria.

• Dysuria and frequency are more commonly

reported with ureteral & bladder tumors.

Imaging



Plain X-Ray:

•Normal.

•Large renal outline may be seen in a completely

obstructed kidney.

•Displacement of renal calcifications, which occur in

analgesic nephropathy.

•Metastases.


IVU:

• Single or multiple filling defects in renal pelvis/ureter.

• Stipple sign.

• Large renal outline may be seen in a completely obstructed

kidney.

• Displacement of renal calcifications, which occur in analgesic

nephropathy.

• Metastases.


IVU:


Retrograde Pyelography :

• Focal expansion of ureters around

and distal to the mass called the

champagne, or goblet, sign.


Retrograde Pyelography :

•Occasionally, the catheter may coil below the

mass during retrograde catheterization; this is

called the Bergman sign.

US:

• Hypoechoic renal collecting system mass splitting the

central echocomplex with varying degree of

infundibular dilatation.

• Focal hypoechogenicity of adjacent renal cortex

reflects local invasion.

• Occasionally, the central echocomplex may be only

segmentally amputated.

• Normal.


US:



CT:

• Irregular filling defects of the pelvocalyceal system

and ureters, with obstruction and dilatation of the

ureter and pelvis proximal to the lesion.

• Ureteral wall thickening.


CT:

• NECT: TCC is hypoattenuating or isoattenuating relative to the

normal renal parenchyma, and it is hyperattenuating relative to

urine.

• CECT: Mild- to-moderate enhancement.

• DELAYED CECT/CTU: Hypoattenuating relative to opacified

urine.


CT:


MRI:

• TCC has lower signal intensity than the normally high-signal-

intensity urine on T2-weighted images.

• TCC is nearly isointense to renal parenchyma on T1- and T2-

weighted images.

• Moderate enhancement is seen with gadolinium contrast

material.

• MR urography.

transitional cell carcinoma

Health & Medicine

renal tumors

renal pelvisureter

large renal outline

renal pelvic tumors

renal pelvic papillomas

abdominal mass

focal expansion of ureters

stipple sign