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Genito-Urinary
Tumors
Episode 6
Transitional Cell Carcinoma
• Primary neoplasms of the renal collecting
system represent 10% of the renal tumors, of
which...
Transitional Cell Carcinoma
• Bladder TCC is 50 times more common than
renal pelvic tumors. Often, TCCs are multiple,
invo...
Transitional Cell Carcinoma
•The male-to-female ratio is 3-4:1
•50-70 years.
Transitional Cell Carcinoma
Causative agents:
 Exposure to a large variety of chemical
carcinogens:
1. Tobacco.
2. Anilin...
Transitional Cell Carcinoma
Causative agents:
• Chemical carcinogens act locally on the epithelium
causing chronic irritat...
Transitional Cell Carcinoma
Pathology:
Broad classification:
(1) Exophytic papillary lesion (85%).
(2) Non-papillary, non-...
Transitional Cell Carcinoma
Pathology:
Spread:
1. Direct extension into the retroperitoneum.
2. Hematogenous.
3. Lymphatic.
Transitional Cell Carcinoma
Pathology:
Spread:
Metastases from ureteral TCC are far more common
than those from bladder ca...
Transitional Cell Carcinoma
 Hematuria.
• For upper tract TCC pain, abdominal mass
and pyuria.
• Dysuria and frequency ar...
Imaging
Transitional Cell Carcinoma
Transitional Cell Carcinoma
Plain X-Ray:
•Normal.
•Large renal outline may be seen in a completely
obstructed kidney.
•Dis...
Transitional Cell Carcinoma
IVU:
• Single or multiple filling defects in renal pelvis/ureter.
• Stipple sign.
• Large rena...
Transitional Cell Carcinoma
IVU:
Transitional Cell Carcinoma
IVU:
Transitional Cell Carcinoma
IVU:
Transitional Cell Carcinoma
IVU:
Transitional Cell Carcinoma
IVU:
Transitional Cell Carcinoma
IVU:
Transitional Cell Carcinoma
Retrograde Pyelography :
• Focal expansion of ureters around
and distal to the mass called the...
Transitional Cell Carcinoma
Retrograde Pyelography :
• Focal expansion of ureters around
and distal to the mass called the...
Transitional Cell Carcinoma
Retrograde Pyelography :
• Focal expansion of ureters around
and distal to the mass called the...
Transitional Cell Carcinoma
Retrograde Pyelography :
•Occasionally, the catheter may coil below the
mass during retrograde...
US:
• Hypoechoic renal collecting system mass splitting the
central echocomplex with varying degree of
infundibular dilata...
US:
Transitional Cell Carcinoma
US:
Transitional Cell Carcinoma
US:
Transitional Cell Carcinoma
US:
Transitional Cell Carcinoma
Transitional Cell Carcinoma
CT:
• Irregular filling defects of the pelvocalyceal system
and ureters, with obstruction and ...
Transitional Cell Carcinoma
CT:
• NECT: TCC is hypoattenuating or isoattenuating relative to the
normal renal parenchyma, ...
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
CT:
Transitional Cell Carcinoma
MRI:
• TCC has lower signal intensity than the normally high-signal-
intensity urine on T2-wei...
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Transitional cell carcinoma

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Transitional cell carcinoma

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Transitional cell carcinoma

  1. 1. Genito-Urinary Tumors Episode 6
  2. 2. 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).
  3. 3. Transitional Cell Carcinoma • Bladder TCC is 50 times more common than renal pelvic tumors. Often, TCCs are multiple, involving any part or all of the collecting system.
  4. 4. Transitional Cell Carcinoma •The male-to-female ratio is 3-4:1 •50-70 years.
  5. 5. Transitional Cell Carcinoma 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.
  6. 6. Transitional Cell Carcinoma 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.
  7. 7. Transitional Cell Carcinoma Pathology: Broad classification: (1) Exophytic papillary lesion (85%). (2) Non-papillary, non-infiltrating. (3) Infiltrating. (4) Carcinoma in situ.
  8. 8. Transitional Cell Carcinoma Pathology: Spread: 1. Direct extension into the retroperitoneum. 2. Hematogenous. 3. Lymphatic.
  9. 9. Transitional Cell Carcinoma 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.
  10. 10. Transitional Cell Carcinoma  Hematuria. • For upper tract TCC pain, abdominal mass and pyuria. • Dysuria and frequency are more commonly reported with ureteral & bladder tumors.
  11. 11. Imaging Transitional Cell Carcinoma
  12. 12. Transitional Cell Carcinoma 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.
  13. 13. Transitional Cell Carcinoma 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.
  14. 14. Transitional Cell Carcinoma IVU:
  15. 15. Transitional Cell Carcinoma IVU:
  16. 16. Transitional Cell Carcinoma IVU:
  17. 17. Transitional Cell Carcinoma IVU:
  18. 18. Transitional Cell Carcinoma IVU:
  19. 19. Transitional Cell Carcinoma IVU:
  20. 20. Transitional Cell Carcinoma Retrograde Pyelography : • Focal expansion of ureters around and distal to the mass called the champagne, or goblet, sign.
  21. 21. Transitional Cell Carcinoma Retrograde Pyelography : • Focal expansion of ureters around and distal to the mass called the champagne, or goblet, sign.
  22. 22. Transitional Cell Carcinoma Retrograde Pyelography : • Focal expansion of ureters around and distal to the mass called the champagne, or goblet, sign.
  23. 23. Transitional Cell Carcinoma Retrograde Pyelography : •Occasionally, the catheter may coil below the mass during retrograde catheterization; this is called the Bergman sign.
  24. 24. 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. Transitional Cell Carcinoma
  25. 25. US: Transitional Cell Carcinoma
  26. 26. US: Transitional Cell Carcinoma
  27. 27. US: Transitional Cell Carcinoma
  28. 28. US: Transitional Cell Carcinoma
  29. 29. Transitional Cell Carcinoma 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.
  30. 30. Transitional Cell Carcinoma 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.
  31. 31. Transitional Cell Carcinoma CT:
  32. 32. Transitional Cell Carcinoma CT:
  33. 33. Transitional Cell Carcinoma CT:
  34. 34. Transitional Cell Carcinoma CT:
  35. 35. Transitional Cell Carcinoma CT:
  36. 36. Transitional Cell Carcinoma CT:
  37. 37. Transitional Cell Carcinoma CT:
  38. 38. Transitional Cell Carcinoma CT:
  39. 39. Transitional Cell Carcinoma 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.

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