Transitional cell carcinoma other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief:  Suveenkrishna Pothuru, M.B,B.S. [2]

## Overview[edit | edit source]

CT urography may be diagnostic of transitional cell carcinoma. Findings on CT urography suggestive of upper urinary tract transitional cell carcinoma include filling defect within the renal collecting system, distortion, obliteration, or amputation of calices, and stipple sign.[1]

## Other Imaging Fidings[edit | edit source]

### CT Urography[edit | edit source]

* An IVP can visualize both the bladder and upper urinary tracts. IVP is an appropriate choice for patients with microscopic or gross hematuria or suspected urothelial cancer.[2]
* IVP is more sensitive for detection of small lesions of the ureter or renal pelvis, while CT scan and renal US are better tests for the evaluation of renal parenchymal disease.
* IVP may not be appropriate in patients :

1. renal insufficiency
2. diabetes mellitus
3. Conditions due to the risk of acute renal injury.

* history of allergies to radiocontrast agents
* In patients in whom the ureters and renal pelvis are poorly visualized by IVP, retrograde pyelograms may be performed during cystoscopy.
* The cystogram phase of the IVP detects 60 to 85 percent of large bladder tumors.
* Both the cystogram phase and the post-void film should be examined for filling defects which are usually irregular, frond-like, or nodular.
* Filling defects may be the result of parietal tumor implantation, the uneven jagged contours of papillary fronds, or obstruction of a ureter with proximal dilation.
* The classic urographic findings of an upper tract TCC are a meniscus-shaped ureteral filling defect known as the "goblet" or "Bergmann" sign and the "stipple sign," produced by contrast being trapped in the fronds of a papillary tumor.
* Approximately 50 percent of patients with a filling defect in the renal pelvis or ureter will have associated hydronephrosis, hydroureter, or nonvisualization of the kidney secondary to obstruction
* Invasive bladder tumors may cause distal ureteral obstruction and secondary hydronephrosis.[3]
* Invasion of tumor into the renal parenchyma lads to non visulization of kdney in advanced disease and is frequently associated with .
* Stenosis is also a specific sign of infiltrating disease and is more commonly seen in the ureter.

* References

1. ↑ Kirkali, Ziya; Tuzel, Emre (2003). "Transitional cell carcinoma of the ureter and renal pelvis". Critical Reviews in Oncology/Hematology. 47 (2): 155–169. doi:10.1016/S1040-8428(03)00079-9. ISSN 1040-8428.
2. ↑ Khadra MH, Pickard RS, Charlton M, Powell PH, Neal DE (2000). "A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice". J Urol. 163 (2): 524–7. PMID 10647670.CS1 maint: Multiple names: authors list (link)
3. ↑ Mitra AP, Skinner EC, Miranda G, Daneshmand S (2013). "A precystectomy decision model to predict pathological upstaging and oncological outcomes in clinical stage T2 bladder cancer". BJU Int. 111 (2): 240–8. doi:10.1111/j.1464-410X.2012.11424.x. PMID 22928881.CS1 maint: Multiple names: authors list (link)

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