Needle tract seeding of transitional cell carcinoma following fine-needle aspiration of a renal mass

Ultrasound-guided catheter biopsy of the lower urinary tract: technique and results in 12 dogs

Ultrasound-guided catheter biopsy of lesions affecting the lower urinary tract was attempted in 12 dogs with mucosal lesions affecting the bladder (nine) or urethra (three). Histological biopsies were obtained by catheter biopsy in 10 dogs, enabling diagnosis of transitional cell carcinoma in five, papilloma in two, prostatic carcinoma in two and chronic cystitis in one. Cytological samples alone were obtained in two dogs, one of which enabled a diagnosis of transitional cell carcinoma; the other contained evidence of haemorrhage and inflammation, but squamous cell carcinoma was found in a subsequent excisional biopsy. Intravesicular haemorrhage after biopsy was observed ultrasonographically in two dogs. Ultrasound guidance enables accurate determination of biopsy catheter position. The size of biopsies obtained by this method may limit the accuracy of histological diagnosis.

Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis

PURPOSE

The application of conservative surgery has been established in the treatment of transitional cell tumors of the renal pelvis. We reviewed retrospectively the long-term outcome after percutaneous treatment of select patients referred to a tertiary center with transitional cell tumors of the renal pelvis.

MATERIALS AND METHODS

We studied 28 patients referred with a presumptive diagnosis of transitional cell carcinoma of the renal pelvis based on filling defects noted on excretory urograms. At percutaneous endoscopy tumor was resected in 26 patients, while no tumor was found in 2. All 19 men and 7 women smoked, and mean age at presentation was 65 years. Of the patients 18 presented with hematuria and 6 had bilateral upper tract tumors. After percutaneous resection, the access tract was irradiated either with iridium wire in 12 patients or a commercial high dose rate radiation delivery system in 12. Thiotepa was instilled into the nephrostomy tube without brachytherapy in 1 patient and 1 received no adjuvant treatment in all. All patients were followed by excretory urography and urine cytology. Cystoscopy and retrograde pyelography were performed when technically possible.

RESULTS

After percutaneous tumor resection 6 patients (23%) had local recurrence in the treated renal pelvis, including 3 at 44, 55 and 60 months, respectively. Further conservative treatment was initially possible in 4 of these patients but ultimately only 2 (both of whom had late recurrences) retained the treated kidney. Of the 11 patients with recurrence elsewhere in the urinary tract the bladder was invariably involved (11), while synchronous or metachronous ureteral recurrence was less common (3). Nine patients remained free of any urothelial recurrence in the upper or lower tract. No patient had recurrent tumor in the nephrostomy tract. Of the patients 7 suffered from procedure-related complications, including 1 who had a persistent urinary fistula that failed to heal after brachytherapy and required nephroureterectomy. There have been 6 deaths during followup, of which 2 were disease related. The 3-year estimated local recurrence-free survival rate was 86% (95% confidence interval 63 to 95%), cause-specific survival rate 91% (95% confidence interval 67 to 98%) and overall survival rate 78% (95% confidence interval 55 to 90%). Differences in recurrence-free survival, comparing those with recurrence in the treated renal pelvis or elsewhere in the urothelium and those remaining disease-free, did not translate to a significant overall survival difference (p < 0.5) between these groups.

CONCLUSIONS

Our results suggest that the combination of percutaneous local resection and tract irradiation offers an effective long-term alternative to radical extirpation in the management of select patients with superficial transitional cell carcinoma confined to the renal pelvis. When the postoperative nephrostogram demonstrates a leaking renal pelvis, tract irradiation should not be given.