Download - Transitional cell carcinoma
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TRANSITIONAL CELL CARCINOMAUpper urinary tract
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Transitional Cell Carcinoma
• Originates from Transitional epithelium of urinary tract. • Most common in urinary bladder, then in renal pelvis,
least in ureter(125:2.5:1)
• 5-10% of upper urinary tract neoplasms.
• Renal TCC most common --extrarenal part of the pelvis, followed by the infundibulocaliceal region
• 2%–4% ---bilaterally.
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Clinical features:• most common in 7th decade, rare in childhood
• males 3 times > female
• typically presents with hematuria
• 1/3 -- flank pain or acute renal colic
• discovered incidentally at radiologic examination
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Tumor spreads by
• mucosal extension
• local
• Hematogenous
• lymphatic invasion
• The most common sites for metastases are the liver, bone, and lungs
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ETIOLOGY
• Increasing age • Male gender • Most important risk factor is smoking, 2-3 times
• Chemical carcinogens (aniline, benzidine, aromatic amine, azo dyes),
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• Cyclo-phosphamide therapy
• Heavy caffeine consumption.
• Stasis of urine and structural abnormalities such as horseshoe kidney.
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IMAGING MODALITIES
INTRAVENOUS UROGRAPHY
• noninvasive method of choice.
• detailed anatomy of the pelvicalyceal system and ureters.
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• a filling defect within the contrast-enhanced collecting system, single or multiple & smooth, irregular or stippled
• Stipple sign---tracking of contrast material into the interstices of a papillary lesion
• Tumor-filled, distended calyces --“oncocalyces.”
• If these fail to opacify with contrast-- “phantom calyces.”
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Retrograde Pyelography• in inadequately excreting kidneys,
• in cases of contrast allergy.
• facilitates ureterorendoscopy with biopsy or brushing & cytology of urine
• an intraluminal filling defect,-- smooth, irregular, or stippled.
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• An “apple core” appearance-- eccentric or encircling ureteric lesions
• localized ureteric dilatation around and distal to the filling defect may give rise to the “goblet” sign.
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Ultrasonography • a central soft-tissue mass in the echogenic renal sinus,
with or without hydronephrosis.
• TCC is usually slightly hyperechoic relative to surrounding renal parenchyma; occasionally, areas of mixed echogenicity.
• typically TCC is infiltrative and does not distort the renal contour.
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• US has a limited role in the evaluation of ureteric TCC
• If visualized, these tumors are typically intraluminal soft-tissue masses with proximal distention of the ureter
• US also allows limited assessment of periureteric tissues.
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Computed Tomography• CT is well established in the preoperative staging and
assessment of upper tract TCC.
CT urography
• single breath-hold coverage of the entire urinary tract,• has improved resolution • has the ability to capture multiple phases of contrast
material excretion
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• hyperdense (5–30 HU) to urine and renal parenchyma but hypodense than other pelvic filling defects such as clot or calculus.
• typically seen as a sessile filling defect or
• pelvicaliceal irregularity, focal or diffuse mural thickening, oncocalyx, and focally obstructed calyces.
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• Advanced TCC extends into the renal parenchyma in an infiltrating pattern --- distorts normal architecture
• However, reniform shape is typically preserved (unlike in
renal cell carcinoma)
• enhances poorly after IV contrast
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• Hydronephrosis and hydroureter
• Ureteric TCC-- Ureteric wall thickening (eccentric or circumferential), luminal narrowing, or an infiltrating mass.
• A thickened enhancing ureteric wall with periureteric fat stranding -- suggestive of extramural spread
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TCC of the renal pelvis in a 60-year-old man with painless hematuria. Fifteen-minute IVU image shows a large irregular filling defect (arrow) involving the right renal pelvis and extending into the lower pole calyceal system
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TCC of the renal pelvis in a 65-year-old man. Fifteen-minute IVU image shows a large stippled filling defect involving the collecting system of the right kidney.
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TCC of the upper pole collecting system in a 55-year-old woman. Fifteen-minute IVU image shows amputation of the upper pole calyx secondary to TCC.
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Ureteric TCC in a 68-year-old woman. RP image shows a long irregular stricture of the left distal ureter with proximal hydroureter and “shouldering” .
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Renal TCC in a 59-year-old woman. Sagittal US scan shows a well defined hyerechoic mass in the upper pole. Tumor tissue is more echogenic than the surrounding renal cortex but less echogenic than renal sinus fat.
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Renal TCC in a 65-year-old woman. Sagittal US scan shows a large mass of mixed echogenicity (arrows) involving the upper pole and overlying renal parenchyma.
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TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. Axial nonenhanced CT scan shows a mass in the right renal pelvis. The mass is slightly hyperdense relative to the urine and renal parenchyma.
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Post contrast image shows characteristic early enhancement of the mass, which is less than that of the surrounding renal parenchyma.
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Renal TCC in a 53-year-old man. Axial nephrographic phase CT scan shows a well defined heterogenous hypodense lesion in the left kidney with preservation of its reniform contour
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Bilateral ureteric TCC in a 57-year-old woman. Coronal T2-weighted MR image show low-signal-intensity tumors in the distal right and distal left ureters.
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Renal TCC in a 68-year-old woman. Coronal gadolinium-enhanced MR angiogram shows a moderately enhancing TCC in the upper pole of the right kidney
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Thank You
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