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Transitional Cell Neoplasm of the Upper Urinary Tract: Evaluation with MDCT

¹ All authors: The Russell H. Morgan Department of Radiology and Radiological Science and Johns Hopkins Hospital, 601 N Caroline St., Baltimore, MD 21287.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Papillary transitional cell neoplasm of low malignant potential. Corticomedullary phase axial image shows small enhancing mass (arrow) in right renal pelvis.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Papillary transitional cell neoplasm of low malignant potential. Excretory phase axial (B) and anterior volume-rendered (C) images show small mass (arrow) seen as filling defect. Ureteroscopy showed small approximately 0.5-cm papillary-appearing lesion in renal pelvis anteriorly. Pathologically, this was papillary transitional cell neoplasm of low malignant potential.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Papillary transitional cell neoplasm of low malignant potential. Excretory phase axial (B) and anterior volume-rendered (C) images show small mass (arrow) seen as filling defect. Ureteroscopy showed small approximately 0.5-cm papillary-appearing lesion in renal pelvis anteriorly. Pathologically, this was papillary transitional cell neoplasm of low malignant potential.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Transitional cell carcinoma of right renal pelvis. Patient has history of hematuria and was found to have transitional cell carcinoma of bladder and right renal pelvis. Corticomedullary phase axial (A) and oblique coronal (B) images show enhancing soft-tissue mass in right upper pole renal calyx (arrows).

View larger version (193K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Transitional cell carcinoma of right renal pelvis. Patient has history of hematuria and was found to have transitional cell carcinoma of bladder and right renal pelvis. Corticomedullary phase axial (A) and oblique coronal (B) images show enhancing soft-tissue mass in right upper pole renal calyx (arrows).

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Transitional cell carcinoma of right renal pelvis. Patient has history of hematuria and was found to have transitional cell carcinoma of bladder and right renal pelvis. Excretory phase axial image shows small filling defect in right upper pole renal calyx (arrow). Pathologically, this was noninvasive papillary transitional cell carcinoma (pTa).

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Transitional cell carcinoma of left renal pelvis. Unenhanced axial (A) and corticomedullary phase oblique coronal (B) images show soft-tissue mass in lower portion of left renal pelvis and lower pole calyx (arrow) with punctuate calcification (arrowhead, A). Note obliteration of peripelvic fat. No clear border between mass and renal parenchyma is seen.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Transitional cell carcinoma of left renal pelvis. Unenhanced axial (A) and corticomedullary phase oblique coronal (B) images show soft-tissue mass in lower portion of left renal pelvis and lower pole calyx (arrow) with punctuate calcification (arrowhead, A). Note obliteration of peripelvic fat. No clear border between mass and renal parenchyma is seen.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Transitional cell carcinoma of left renal pelvis. Excretory phase oblique coronal image shows hypoattenuating mass in lower pole calyx involving renal parenchyma (arrows). Pathologically, this was high-grade invasive transitional cell carcinoma infiltrating into renal parenchyma (stage pT3).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Multifocal transitional cell carcinoma after cystoprostatectomy for bladder cancer. Corticomedullary phase coronal image shows multifocal enhancing masses in renal pelvis and calyces of bilateral kidneys (white arrows). Enhancing mass is also present in proximal left ureter (black arrow). Pathologically, masses were high-grade papillary transitional cell carcinoma with widespread involvement of ureter and renal pelvis on both sides with invasion into renal parenchyma bilaterally (stage pT3).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Transitional cell carcinoma of right ureter. CT was performed for evaluation for aortic aneurysm. Corticomedullary phase axial (A), oblique sagittal (B), and oblique coronal (C) images show enhancing soft-tissue mass involving distal right ureter (arrows, A and B). Note right hydronephrosis and hydroureter with decreased enhancement of right kidney. There is additional small focus of enhancing soft tissue in proximal right ureter (arrowhead, B and C). Pathologically, distal ureteral lesion was high-grade transitional cell carcinoma invading muscularis (stage pT2). Proximal ureteral lesion was high-grade noninvasive papillary transitional cell carcinoma (stage pTa).

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Transitional cell carcinoma of right ureter. CT was performed for evaluation for aortic aneurysm. Corticomedullary phase axial (A), oblique sagittal (B), and oblique coronal (C) images show enhancing soft-tissue mass involving distal right ureter (arrows, A and B). Note right hydronephrosis and hydroureter with decreased enhancement of right kidney. There is additional small focus of enhancing soft tissue in proximal right ureter (arrowhead, B and C). Pathologically, distal ureteral lesion was high-grade transitional cell carcinoma invading muscularis (stage pT2). Proximal ureteral lesion was high-grade noninvasive papillary transitional cell carcinoma (stage pTa).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Transitional cell carcinoma of right ureter. CT was performed for evaluation for aortic aneurysm. Corticomedullary phase axial (A), oblique sagittal (B), and oblique coronal (C) images show enhancing soft-tissue mass involving distal right ureter (arrows, A and B). Note right hydronephrosis and hydroureter with decreased enhancement of right kidney. There is additional small focus of enhancing soft tissue in proximal right ureter (arrowhead, B and C). Pathologically, distal ureteral lesion was high-grade transitional cell carcinoma invading muscularis (stage pT2). Proximal ureteral lesion was high-grade noninvasive papillary transitional cell carcinoma (stage pTa).

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Transitional cell carcinoma of right renal pelvis. Corticomedullary phase axial (A) and coronal (B) images show enhancing eccentric wall thickening in right renal pelvis that extends into calyx in mid pole (arrows). Note minimally decreased parenchymal enhancement in anterior aspect of right kidney (arrowheads, A).

View larger version (182K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Transitional cell carcinoma of right renal pelvis. Corticomedullary phase axial (A) and coronal (B) images show enhancing eccentric wall thickening in right renal pelvis that extends into calyx in mid pole (arrows). Note minimally decreased parenchymal enhancement in anterior aspect of right kidney (arrowheads, A).

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Transitional cell carcinoma of right renal pelvis. Excretory phase coronal image shows eccentric wall thickening of right renal pelvis and filling defect of mid pole calyx (arrows). Pathologically, this was high-grade papillary transitional cell carcinoma with focal invasion into renal parenchyma (stage pT3). Patient also had thickening of right distal ureter extending into bladder (not shown), which was noninvasive high-grade papillary transitional cell carcinoma.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Transitional cell carcinoma with squamous differentiation of left renal pelvis. Corticomedullary phase axial (A) and oblique coronal (B) images show thickening of left renal pelvis with ill-defined enhancing soft-tissue mass extending into lower pole calices (white arrows). Note focally decreased contrast enhancement in renal parenchyma (arrowheads, B) and ill-defined left paraaortic lymph node (black arrow, B).

View larger version (206K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Transitional cell carcinoma with squamous differentiation of left renal pelvis. Corticomedullary phase axial (A) and oblique coronal (B) images show thickening of left renal pelvis with ill-defined enhancing soft-tissue mass extending into lower pole calices (white arrows). Note focally decreased contrast enhancement in renal parenchyma (arrowheads, B) and ill-defined left paraaortic lymph node (black arrow, B).

View larger version (194K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Transitional cell carcinoma with squamous differentiation of left renal pelvis. Excretory phase coronal image shows ill-defined hypodense mass and obliteration of lower pole calices. Pathologically, this was high-grade transitional cell carcinoma with squamous differentiation invading renal parenchyma (stage pT3). There was metastasis in regional lymph nodes.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —Papillary transitional cell neoplasm of low malignant potential in right ureter. Corticomedullary phase coronal image shows enhancing lesion in right ureter (arrows), proximal hydronephrosis, and hydroureter. Note also parapelvic cyst of left kidney. Contrast enhancement of right kidney is decreased compared with left kidney.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —Papillary transitional cell neoplasm of low malignant potential in right ureter. Excretory phase axial image shows enhancement and eccentric thickening in right ureter (arrow), which is not yet opacified. Pathologically, this was papillary transitional cell neoplasm (2.6 cm) of right ureter with low malignant potential.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —Flat transitional cell carcinoma in situ involving left ureter after radical cystoprostatectomy for bladder cancer. Patient underwent neobladder reconstruction 9 years previously and developed left hydronephrosis. Patient then underwent left percutaneous nephrostomy tube placement. Excretory phase axial (A) and oblique coronal (B) images show diffuse thickening and periureteric stranding of left ureter (arrows). Excreted contrast material is seen in normal right ureter (arrowhead, A). Periureteric stranding is possibly related to percutaneous nephrostomy tube and prior biopsy. Pathologically, this was flat transitional cell carcinoma in situ involving approximately two thirds of distal left ureter (stage pTis).

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —Flat transitional cell carcinoma in situ involving left ureter after radical cystoprostatectomy for bladder cancer. Patient underwent neobladder reconstruction 9 years previously and developed left hydronephrosis. Patient then underwent left percutaneous nephrostomy tube placement. Excretory phase axial (A) and oblique coronal (B) images show diffuse thickening and periureteric stranding of left ureter (arrows). Excreted contrast material is seen in normal right ureter (arrowhead, A). Periureteric stranding is possibly related to percutaneous nephrostomy tube and prior biopsy. Pathologically, this was flat transitional cell carcinoma in situ involving approximately two thirds of distal left ureter (stage pTis).

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —Transitional cell carcinoma of left renal pelvis in patient with history of bladder cancer. Corticomedullary phase axial (A) and excretory phase coronal (B) images show large mass filling left renal pelvis and infiltrating renal parenchyma in lower pole (arrows). Ureteroscopy showed large mass in left renal pelvis and infundibular stenosis in lower pole due to mass. Biopsy showed transitional cell carcinoma.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —Transitional cell carcinoma of left renal pelvis in patient with history of bladder cancer. Corticomedullary phase axial (A) and excretory phase coronal (B) images show large mass filling left renal pelvis and infiltrating renal parenchyma in lower pole (arrows). Ureteroscopy showed large mass in left renal pelvis and infundibular stenosis in lower pole due to mass. Biopsy showed transitional cell carcinoma.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —Transitional cell carcinoma with squamous differentiation. Corticomedullary phase axial (A) and oblique coronal (B) images show large infiltrating mass in right renal hilum causing hydronephrosis. Note hypodense retroperitoneal adenopathy (arrowhead, A). Mass infiltrates renal parenchyma and encases right renal arteries (arrows).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —Transitional cell carcinoma with squamous differentiation. Corticomedullary phase axial (A) and oblique coronal (B) images show large infiltrating mass in right renal hilum causing hydronephrosis. Note hypodense retroperitoneal adenopathy (arrowhead, A). Mass infiltrates renal parenchyma and encases right renal arteries (arrows).

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —Transitional cell carcinoma with squamous differentiation. Excretory phase coronal image shows marked right hydronephrosis due to hypodense right renal hilar mass (arrows). Pathologically, this was high-grade transitional cell carcinoma with squamous differentiation. Tumor invaded periureteric fat and peripelvic fat and renal parenchyma. There was metastasis in regional lymph node.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —Flat in situ transitional cell carcinoma in left renal pelvis after cystectomy for bladder carcinoma. Ureteroscopy did not show any frank filling defect or mucosal lesion; however, brush biopsy specimen from left renal pelvis showed high-grade transitional cell carcinoma. Corticomedullary phase coronal (A) and excretory phase coronal (B) images show no obvious abnormalities in left renal pelvis on soft-tissue or wide window setting despite careful evaluation with scrolling axial and multiplanar reformation images. Patient underwent left laparoscopic nephroureterectomy. Pathology found multifocal flat in situ transitional cell carcinoma involving left renal pelvis.

View larger version (192K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —Flat in situ transitional cell carcinoma in left renal pelvis after cystectomy for bladder carcinoma. Ureteroscopy did not show any frank filling defect or mucosal lesion; however, brush biopsy specimen from left renal pelvis showed high-grade transitional cell carcinoma. Corticomedullary phase coronal (A) and excretory phase coronal (B) images show no obvious abnormalities in left renal pelvis on soft-tissue or wide window setting despite careful evaluation with scrolling axial and multiplanar reformation images. Patient underwent left laparoscopic nephroureterectomy. Pathology found multifocal flat in situ transitional cell carcinoma involving left renal pelvis.

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