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UROEPITHELIAL TUMORS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY LOYOLA UNIVERSITY MEDICA

UROEPITHELIAL TUMORS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY LOYOLA UNIVERSITY MEDICAL CENTER. UROEPITHELIAL TUMORS INCIDENCE. URINARY BLADDER (94% OF ALL UROEPITHELIAL TUMORS) RENAL PELVIS (5% OF ALL UROTHELIAL TUMORS) URETER

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UROEPITHELIAL TUMORS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY LOYOLA UNIVERSITY MEDICA

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  1. UROEPITHELIAL TUMORS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY LOYOLA UNIVERSITY MEDICAL CENTER

  2. UROEPITHELIAL TUMORS INCIDENCE • URINARY BLADDER(94% OF ALL UROEPITHELIAL TUMORS) • RENAL PELVIS • (5% OF ALL UROTHELIAL TUMORS) • URETER • (1% OF ALL UROTHELIAL TUMORS)

  3. UROEPITHELIAL TUMORSINCIDENCE • URINARY BLADDER • (50 THOUSAND NEW CASES BLADDER CA/YEAR IN USA) M:F 3:1 • RENAL CELL CARCINOMA OF KIDNEY • (15,000 THOUSAND NEW CASES/YEAR IN USA)

  4. UROEPITHELIAL TUMORSRISK FACTORS • SMOKING • ANALGESICS • PHENACETIN • CYCLOPHOSPHAMIDE • OCCUPATIONAL CARCINOGENS • COAL, ASPHALT, TAR, PETROCHEMICALS, PLASTICS • PAPILLARY NECROSIS • FAMILIAL CANCER SYNDROMES • HEREDITARY NONPOLYPOSIS COLORECTAL CANCER (LYNCHII)

  5. UROEPITHELIAL TUMORS COLLECTING SYSTEM DEVELOPES FROM FETAL MESONEPHROS UROEPITHELIAL CA: TRANSITIONAL CELL OR SQUAMOUS CARCINOMA DERIVED FROM • MESODERM • EPITHELIAL TISSUE RENAL PARENCHYMA DEVELOPES FROM METANEPHRIC BLASTEMA RENAL CELL CA: ADENOCARCINOMA DERIVED FROM • TUBULAR EPITHELIUM

  6. UROEPITHELIAL TUMORS • 90% TRANSITIONAL CELL • 9% SQUAMOUS CELL • >1% • ADENOCARCINOMA • SARCOMA • UNDIFFERENTIATED • BENIGN MESODERMAL

  7. UROEPITHELIAL TUMORTRANSITIONAL, SQUAMOUS, AND SARCOMA ELEMENTS

  8. TRANSITIONAL CELL CARCINOMA

  9. TRANSITIONAL CELL CARCINOMA CLASSIFICATION PAPILLARY NONPAPILLARY

  10. TRANSITIONAL CELL CARCINOMA • PAPILLARY TYPE 80% • 50% ARE INFILTRATIVE MALIGNANCIES • NONPAPILLARY TYPE 20% • ALL CONSIDERED TO BE MALIGNANT

  11. PAPILLARY CARCINOMAINVASIVE VERSUS NONINVASIVE

  12. NONPAPILLARY (FLAT) CARCINOMAINVASIVE VERSUS NONINVASIVE

  13. TRANSITIONAL CELL TUMORS • PATHOLOGIC CLASSIFICATION RANGE • WELL DIFFERENTIATED PAPILLOMA (GRADE 1) • MALIGNANCY RANGES FROM LOW-GRADE AND SUPERFICIAL TO HIGH-GRADE AND INVASIVE

  14. UROEPITHELIAL TUMORSIMAGING MODALITIES • EXCRETORY UROGRAM • SONOGRAPHY • RETROGRADE PYELOGRAM • COMPUTED TOMOGRAPHY • ANGIOGRAPHY

  15. TRANSITIONAL CELL TUMORS GROSS APPEARANCE ON IMAGING STUDIES • SINGLE LESION • SMALL AND PAPILLARY TO BULKY AND SESSILE • MULTIPLE DISCRETE LESIONS • DIFFUSE AND CONFLUENT LESIONS

  16. TRANSITIONAL CARCINOMA RENAL PELVIS

  17. UROEPITHELIAL TUMORS • PAPILLARY TYPE • STIPPLED APPEARANCE

  18. TRANSITIONAL CELL CAPAPILLARY TYPESTIPPLED APPEARANCE

  19. TRANSITIONAL CELL CARCINOMA • TENDENCY TO BE MULTICENTRIC AND BILATERAL • BILATERAL IN UP TO 10% OF PATIENTS • (SYNCHRONOUS OR METACHRONOUS) • UP TO 1/2 OF PATIENTS WITH CA URETER OR PELVIS WILL DEVELOP BLADDER CARCINOMA

  20. MULTIPLE TRANSITIONAL CELL CARCINOMAS

  21. TRANSITIONAL CELL CARCINOMA PROGNOSIS • PATIENTS WITH A RENAL PELVIC PAPILLOMA • 1/4 WILL DEVELOP A CARCINOMA • PATIENTS WITH MULTIPLE PAPILLOMAS • 1/2 WILL DEVELOP A CARCINOMA • PATIENTS WITH BLADDER/URETER TRANSITIONAL NEOPLASM • 1/3 ALREADY HAVE ANOTHER BLADDER TCC

  22. SQUAMOUS CARCINOMA

  23. SQUAMOUS TUMORS • ASSOCIATED WITH INFECTION AND STONES, LEUKOPLAKIA • SQUAMOUS METAPLASIA OF TRANSITIONAL EPITHELIUM • MOST ARE SOLITARY • CAN BE PAPILLARY OR SESSILE • HIGHLY INVASIVE • OVERALL, POOR PROGNOSIS

  24. HEMATURIASQUAMOUS CARCINOMA INITIAL CT CT 8 MONTHS LATER

  25. SQUAMOUS TUMORS • DIFFICULT TO RECOGNIZE DUE TO UNDERLYING DISEASE • INFECTION • STONES • OFTEN INVASIVE OR METASTATIC AT TIME OF DIAGNOSIS • PREDOMINENTLY EXTRALUMINAL • MAY APPEAR AS URETERAL STRICTURE

  26. DISTAL URETERAL UROEPITHELIAL TUMORSQUAMOUS CARCINOMA

  27. UROEPITHELIAL NEOPLASMS IMAGING

  28. UROEPITHELIAL TUMORSIMAGING COLLECTING SYSTEM CALYCES INFUNDIBULI PELVIS URETERS BLADDER

  29. UROEPITHELIAL TUMORS • RENAL PELVIS

  30. TRANSITIONAL CELL CARCINOMA INVADES KIDNEY

  31. LARGE, INVASIVE UROEPITHEAL TUMOR RENAL PELVIS

  32. TRANSITIONAL CELL CARCINOMARENAL PELVIS

  33. HEMATURIA IVP 1YEAR LATER TWO RETROGRADES INITIAL IVP

  34. NONFUNCTIONING KIDNEY

  35. TRANSITIONAL CELL CAPAPILLARY TYPESTIPPLED APPEARANCE

  36. RENAL SINUSFAT, OPACIFIED CALYX, TUMOR

  37. 48-YEAR-OLD WOMAN PERSISTENT ABDOMINAL PAIN CT ONE YEAR LATER

  38. CT10 mm VERSUS 5 mm COLLIMATION

  39. TRANSITIONAL CELL CA PELVISCT AND ANGIOGRAPHY

  40. UROEPITHELIAL TUMORS • CALYCES

  41. TRANSITIONAL CELL CA CT IVP RETROGRADE

  42. TRANSITIONAL CELL CALOWER POLE CALYX

  43. TRANSITIONAL CELL CARCINOMACT, IVP, RETROGRADE PYELOGRAM

  44. TRANSITIONAL CELL CARCINOMA DILATED CALYX IVP RETROGRADE

  45. TRANSITIONAL CELL CAAMPUTATED CALYX

  46. HEMATURIA 70/M IVP CT 1 YEAR LATER

  47. TRANSITIONAL CELL CARCINOMAPAPILLARY TYPE WITH STIPPLING

  48. TRANSITIONAL CELL CASUBTLE

  49. UROEPITHELIAL TUMORS • URETER

  50. GROSS HEMATURIADISTAL URETERAL CA

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