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Chen X, Feng X, Chen Y, Huang F, Long L. CT findings and clinical characteristics in distinguishing renal urothelial carcinoma mimicking renal cell carcinoma from clear cell renal cell carcinoma. BMC Urol 2024; 24:4. [PMID: 38172791 PMCID: PMC10765735 DOI: 10.1186/s12894-023-01393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to characterize the clinical and multiphase computed tomography (CT) features, which can distinguish renal urothelial carcinoma (RUC) mimicking renal cell carcinoma (RCC) from clear cell renal cell carcinoma (ccRCC) with collecting system invasion (CSI). METHODS Data from 56 patients with RUC (46 men and 10 women) and 366 patients with ccRCC (262 men and 104 women) were collected and assessed retrospectively. The median age was 65.50 (IQR: 56.25-69.75) and 53.50 (IQR: 42.25-62.5) years, respectively. Univariate and multivariate logistic regression analyses were performed on clinical and CT characteristics to determine independent factors for distinguishing RUC and ccRCC, and an integrated predictive model was constructed. Differential diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS The independent predictors for differentiating RUC from ccRCC were infiltrative growth pattern, hydronephrosis, heterogeneous enhancement, preserving reniform contour, and hematuria. The differential diagnostic performance of the integrated predictive model-1 (AUC: 0.947, sensitivity: 89.07%, specificity: 89.29%) and model-2 (AUC: 0.960, sensitivity: 92.1%, specificity: 89.3%) were both better than that of the infiltrative growth pattern (AUC: 0.830, sensitivity: 71.9%, specificity: 92.9%), heterogeneous enhancement (AUC: 0.771, sensitivity: 86.3%, specificity: 67.9%), preserving reniform contour (AUC = 0.758, sensitivity: 85.5%, specificity: 66.1%), hydronephrosis (AUC: 0.733, sensitivity: 87.7%, specificity: 58.9%), or hematuria (AUC: 0.706, sensitivity: 79.5%, specificity: 51.8%). CONCLUSION The CT and clinical characteristics showed extraordinary discriminative abilities in the differential diagnosis of RUC and ccRCC, which might provide helpful information for clinical decision-making.
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Affiliation(s)
- Xin Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China
- Department of Radiology, Jiangjin Hospital of Chongqing University, No.725, Jiangzhou Avenue, Dingshan Street, Chongqing, 402260, China
| | - Xiao Feng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China
| | - Yidi Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, Sichuan, 610041, China
| | - Fulin Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China.
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2
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Abdelaziz A, Sultan M, Hammad MA, Martinez JR, Yacoub M, Youssef RF. Endophytic upper tract urothelial carcinoma in a solitary kidney treated by cryotherapy: an unorthodox case for successful management. BMC Urol 2023; 23:111. [PMID: 37370049 DOI: 10.1186/s12894-023-01279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Nephroureterectomy remains the gold standard treatment for upper tract urothelial carcinoma (UTUC). Considering the high risk of developing renal function impairment after surgery, the rationale for nephron sparing approaches in treatment of UTUC has been raised. In this case, renal cryoablation was able to achieve successful oncologic control while preserving renal function during 5 years of follow up without intraoperative or post operative complications. CASE PRESENTATION A 79 year old male presents after three months of macroscopic hematuria. Imaging revealed a 3.6 × 3.1 × 2.7 cm endophytic mass in the interpolar region of the left kidney and an atrophic right kidney. After weighing the lesion's location with the patient's of complex medical history, he was counselled to undergo a minimally invasive percutaneous cryoablation as treatment for his solitary renal mass. A diagnostic dilemma was encountered as imaging suggested a diagnosis of renal cell carcinoma. However, the pre-ablation biopsy established an alternative diagnosis, revealing UTUC. Percutaneous cryoablation became an unorthodox treatment modality for the endophytic component of his UTUC followed by retrograde ureteroscopic laser fulguration. The patient was followed in 3 months, 6 months, then annually with cross sectional imaging by MRI, cystoscopy, urine cytology and renal function testing. After five years of follow-up, the patient did not encountered recurrence of UTUC or deterioration in renal function, thereby maintaining a stable eGFR. CONCLUSION Although evidence for nephron-sparing modalities for UTUC is mounting in recent literature, limited data still exists on cryotherapy as a line of treatment for urothelial carcinoma. We report successful management of a low-grade UTUC using cryoablation with the crucial aid of an initial renal biopsy and long-term follow-up. Our results provide insight into the role of cryoablation as a nephron-sparing approach for UTUC.
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Affiliation(s)
- Ahmad Abdelaziz
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Mark Sultan
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Muhammed A Hammad
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Juan Ramon Martinez
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Maria Yacoub
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA
| | - Ramy F Youssef
- Department of Urology, University of California: Irvine, 3800 Chapman Ave, Suite 7200, Orange, CA, 92868, USA.
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3
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Chen X, Feng X, Chen Y, Huang F, Long L. CT findings and clinical characteristics in distinguishing renal urothelial carcinoma mimicking renal cell carcinoma from clear cell renal cell carcinoma.. [DOI: 10.21203/rs.3.rs-2655480/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Background: We aimed to characterize the clinical and multiphase computed tomography (CT) features, which can distinguish renal urothelial carcinoma (RUC) mimicking renal cell carcinoma (RCC) from clear cell renal cell carcinoma (ccRCC) with collecting system invasion (CSI).
Methods: Data from 56 patients with RUC (46 men and 10 women) and 366 patients with ccRCC (262 men and 104 women) were collected and assessed retrospectively. The median age was 65.50 (IQR: 56.25–69.75) and 53.50 (IQR: 42.25–62.5) years, respectively. Univariate and multivariate logistic regression analyses were performed on clinical and CT characteristics to determine independent factors for distinguishing RUC and ccRCC, and an integrated predictive model was constructed. Differential diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC).
Results: The independent predictors for differentiating RUC from ccRCC were infiltrative growth pattern, hydronephrosis, heterogeneous enhancement, preserving reniform contour, and hematuria. The differential diagnostic performance of the integrated predictive model (AUC: 0.960, sensitivity: 92.1%, specificity: 89.3%) was better than that of the infiltrative growth pattern (AUC: 0.830, sensitivity: 71.9%, specificity: 92.9%), heterogeneous enhancement (AUC: 0.771, sensitivity: 86.3%, specificity: 67.9%), preserving reniform contour (AUC=0.758, sensitivity: 85.5%, specificity: 66.1%), hydronephrosis (AUC: 0.733, sensitivity: 87.7%, specificity: 58.9%), or hematuria (AUC: 0.706, sensitivity: 79.5%, specificity: 51.8%).
Conclusion: The CT and clinical characteristics showed extraordinary discriminative abilities in the differential diagnosis of RUC and ccRCC, which might provide helpful information for clinical decision-making.
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Affiliation(s)
| | - Xiao Feng
- First Affiliated Hospital of GuangXi Medical University
| | - Yidi Chen
- West China Hospital of Sichuan University
| | - Fuling Huang
- First Affiliated Hospital of GuangXi Medical University
| | - Liling Long
- First Affiliated Hospital of GuangXi Medical University
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4
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Tumor immunology. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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5
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Tao L, Fan J, Zhan W, Li W, Lu J, Yang N, Ma B, Zhou W. Contrast-enhanced ultrasound manifestations of renal masses undetectable on conventional ultrasound. Front Oncol 2022; 12:943960. [PMID: 35957888 PMCID: PMC9357941 DOI: 10.3389/fonc.2022.943960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to retrospectively analyze the features of contrast-enhanced ultrasound (CEUS) of renal masses that cannot be detected by conventional ultrasound (CUS). The data of 264 patients who underwent CEUS for renal lesions from January 2016 to December 2019 were retrieved. Of these, 16 patients with renal masses which were not detected by CUS were included in the final analysis. The corresponding characteristics of CEUS were evaluated, including intensity of enhancement, homogeneity, wash-in and wash-out patterns, and perilesional rim-like enhancement. Of the 16 patients, 10 patients had clear cell renal cell carcinoma (ccRCC) and 6 patients had urothelial carcinoma of the renal pelvis (UCRP). Compared with the location on non-enhanced computed tomography (CT) scan, all tumors were detected on CEUS. Most (7/10) of the ccRCCs appeared as hyperenhancement, homogeneous enhancement, synchronous-in, and no perilesional rim-like enhancement. Most (4/6) of the UCRPs appeared as isoenhancement, slow-in, fast-out, and no perilesional rim-like enhancement. CEUS may be helpful in the diagnosis and differential diagnosis of renal tumors which were not observed on CUS, and it might be an alternative method for some patients when contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) cannot be performed.
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Affiliation(s)
- Lingling Tao
- Department of Ultrasound, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinfang Fan
- Department of Ultrasound, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Li
- Department of Ultrasound, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Lu
- Department of Interventional Radiology, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nanan Yang
- Department of Interventional Radiology, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Binbin Ma
- Department of Urology, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Wei Zhou,
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6
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Sanyal SR, Arora A, Nisreen A, Mohamed K, Mohammad SK, Baruah D. Imaging Tips and Tricks in Management of Renal and Urothelial Malignancies. Indian J Radiol Imaging 2022; 32:213-223. [PMID: 35924135 PMCID: PMC9340167 DOI: 10.1055/s-0042-1744520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractManagement of urological malignancies has evolved significantly with continually changing guidelines and treatment options which demand more centralized involvement of radiology than ever before.Radiologists play a pivotal role in interpreting complex cancer scans and guiding clinical teams toward the best management options in the light of clinical profile. Management of complex uro-oncology cases is often discussed in multidisciplinary meetings which are essential checkpoints to evaluate an overall picture and formulate optimal treatment plans.The aim of this article is to provide a radiological perspective with practical guidance to fellow radiologists participating in uro-oncology multidisciplinary meetings based on commonly encountered case scenarios, updated guidelines, and cancer pathways.Crucial imaging tips with regards to renal and urinary tract cancers, upon which therapeutic decisions are made, have been condensed in this article after reviewing several complex cases from urology multidisciplinary meetings and European Association of Urology guidelines.Outline of various diagnostic and management strategies, key staging features, surveillance guidelines, and, above all, what the onco-urologists want to know from radiologists have been succinctly discussed in this article.
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Affiliation(s)
| | - Ankur Arora
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trusst, Liverpool, United Kingdom
| | - Amin Nisreen
- Department of Radiology, Royal Preston Hospital, Preston, United Kingdom
| | - Khattab Mohamed
- Department of Radiology, Royal Preston Hospital, Preston, United Kingdom
| | | | - Deb Baruah
- Department of Radiology, Tezpur Medical College, Assam, India
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7
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Shimada W, Tanaka H, Fukawa Y, Kimura K, Yamamoto K, Fukuda S, Fukushima H, Yasuda Y, Uehara S, Yoshida S, Yokoyama M, Matsuoka Y, Tateishi U, Campbell SC, Fujii Y. Infiltrative tumor interface with normal renal parenchyma in locally advanced renal cell carcinoma: Clinical relevance and pathological implications. Int J Urol 2021; 28:1233-1239. [PMID: 34414613 DOI: 10.1111/iju.14673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/27/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Locally advanced renal cell carcinoma is considered clinically aggressive, despite heterogeneity in survival outcomes. We investigated the clinical relevance and pathological implications of infiltrative tumor interface with normal renal parenchyma on preoperative imaging in locally advanced renal cell carcinoma. METHODS A total of 77 patients with locally advanced renal cell carcinoma (≥pT3a Nany M0) who underwent radical or partial nephrectomy (2008-2018) were analyzed. Preoperative dynamic computed tomography images were reviewed to assess radiological infiltrative features. A radiological infiltrative feature was defined as an ill-defined tumor interface with normal renal parenchyma. The tumor interfaces were analyzed histologically and compared with radiological findings. RESULTS The median tumor size was 6.4 cm. Lymphadenopathy was observed in four patients (5.2%). Clear cell renal cell carcinoma was diagnosed in 66 patients (86%) and Fuhrman grade was 3-4 in 38 patients (49%). A total of 30 patients (39%) showed radiological infiltrative features, which were significantly associated with larger tumor size and higher clinical T stage. The specificity and sensitivity of radiological infiltrative features in predicting pathological renal parenchymal infiltration were 90 and 64%, respectively. During a median follow-up period of 3.8 years, 27 patients (35%) developed cancer recurrences, and six patients (7.8%) died of renal cell carcinoma. Multivariable analysis showed that the presence of radiological infiltrative features was an independent risk factor for cancer recurrence. Cancer recurrence and cancer-specific mortality were significantly stratified by the presence or absence of radiological infiltrative features (P < 0.001 and P = 0.02, respectively). CONCLUSIONS Locally advanced renal cell carcinoma can show radiological infiltrative features preoperatively, which are significantly associated with unfavorable prognosis. Radiological infiltrative features on preoperative imaging correspond with a high specificity to pathological renal parenchymal infiltration.
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Affiliation(s)
- Wataru Shimada
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Fukawa
- Department of, Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Kimura
- Department of, Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kouhei Yamamoto
- Department of, Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Yasuda
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of, Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yasuhisa Fujii
- Departments of, Urology, Tokyo Medical and Dental University, Tokyo, Japan
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8
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Hines JJ, Eacobacci K, Goyal R. The Incidental Renal Mass- Update on Characterization and Management. Radiol Clin North Am 2021; 59:631-646. [PMID: 34053610 DOI: 10.1016/j.rcl.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Renal masses are commonly encountered on cross-sectional imaging examinations performed for nonrenal indications. Although most can be dismissed as benign cysts, a subset will be either indeterminate or suspicious; in many cases, imaging cannot be used to reliably differentiate between benign and malignant masses. On-going research in defining characteristics of common renal masses on advanced imaging shows promise in offering solutions to this issue. A recent update of the Bosniak classification (used to categorize cystic renal masses) was proposed with the goals of decreasing imaging follow-up in likely benign cystic masses, and therefore avoiding unnecessary surgical resection of such masses.
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Affiliation(s)
- John J Hines
- Department of Radiology, Huntington Hospital, Northwell Health, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Katherine Eacobacci
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Riya Goyal
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
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9
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Sweet DE, Ward RD, Wang Y, Tanaka H, Campbell SC, Remer EM. Infiltrative Renal Malignancies: Imaging Features, Prognostic Implications, and Mimics. Radiographics 2021; 41:487-508. [PMID: 33449838 DOI: 10.1148/rg.2021200123] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infiltrative renal malignancies are a subset of renal masses that are morphologically characterized by a poorly defined interface with the renal parenchyma. Infiltrative renal malignancies are less common but more aggressive than more typical renal malignancies and carry an overall worse prognosis. Although an infiltrative renal process often represents a malignant neoplasm, infiltrative masses include a wide spectrum of diseases including primary renal cortical, medullary, and pelvic tumors; lymphoproliferative processes; metastases; and various infectious, inflammatory, immune-mediated, and vascular mimics. The imaging features of these masses are often nonspecific, but with the appropriate history, laboratory results, and clinical context, the radiologist can help narrow the diagnosis and guide further treatment. An invited commentary by Lee is available online.Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- David E Sweet
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Ryan D Ward
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Yanbo Wang
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Hajime Tanaka
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Steven C Campbell
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Erick M Remer
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
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10
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Martingano P, Cavallaro MFM, Bozzato AM, Baratella E, Cova MA. CT Urography Findings of Upper Urinary Tract Carcinoma and Its Mimickers: A Pictorial Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E705. [PMID: 33348865 PMCID: PMC7766367 DOI: 10.3390/medicina56120705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
Urothelial carcinoma (UC) is the fourth most frequent tumor in Western countries and upper tract urothelial carcinoma (UTUC), affecting pyelocaliceal cavities and ureter, accounts for 5-10% of all UCs. Computed tomography urography (CTU) is now considered the imaging modality of choice for diagnosis and staging of UTUC, guiding disease management. Although its specificity is very high, both benign and malignant diseases could mimic UTUCs and therefore have to be well-known to avoid misdiagnosis. We describe CTU findings of upper urinary tract carcinoma, features that influence disease management, and possible differential diagnosis.
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Affiliation(s)
- Paola Martingano
- Department of Radiology, ASUGI, Cattinara Hospital, 34139 Trieste, Italy
| | | | - Alessandro M. Bozzato
- Department of Radiology, University of Trieste, ASUGI, Cattinara Hospital, 34139 Trieste, Italy; (A.M.B.); (E.B.); (M.A.C.)
| | - Elisa Baratella
- Department of Radiology, University of Trieste, ASUGI, Cattinara Hospital, 34139 Trieste, Italy; (A.M.B.); (E.B.); (M.A.C.)
| | - Maria A. Cova
- Department of Radiology, University of Trieste, ASUGI, Cattinara Hospital, 34139 Trieste, Italy; (A.M.B.); (E.B.); (M.A.C.)
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11
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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12
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Palacios DA, Campbell R, Wang Y, Tanaka H, Ding X, Ye YL, Remer EM, Rizk A, Ward R, Haywood S, Campbell SC. Infiltrative Renal Masses: Clinical Challenges. Urology 2020; 145:3-8. [PMID: 33010293 DOI: 10.1016/j.urology.2020.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022]
Affiliation(s)
| | - Rebecca Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Xiaobo Ding
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Yun-Lin Ye
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Erick M Remer
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Alain Rizk
- Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan Ward
- Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Samuel Haywood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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13
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Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease. Abdom Radiol (NY) 2019; 44:3874-3885. [PMID: 31440804 DOI: 10.1007/s00261-019-02173-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urothelial carcinoma of the upper urinary tract (UUT) is a relatively uncommon genitourinary malignancy, accounting for about 5-7% of urothelial tumors. The significant features of this tumor are multifocality and high rate of recurrence. Computed tomography urography (CTU) has replaced excretory urography (EU) and retrograde pyelography (RP) for imaging of upper tract urothelial carcinoma. While many studies have confirmed high sensitivity (88-100%) and specificity (93-100%) of CTU, an optimized CT protocol is of critical importance in screening, staging, and post-operative follow-up of patients (Chlapoutakis, Eur J Radiol 73(2):334-338, 2010; Caoli and Cohan, Abdom Radiol (NY) 41(6):1100-1107, 2016). The key element of the CT protocol is to have adequate distension of the collecting system with excreted contrast, to detect subtle lesions at an early stage. In this article, we discuss the background of upper urinary tract TTC, pathogenesis, CT protocol and the role of imaging in evaluation of this malignancy, staging, as well as different imaging appearances.
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Tanaka H, Ding X, Ye Y, Wang Y, Campbell RA, DeWitt-Foy ME, Suk-Ouichai C, Ward RD, Remer EM, Li J, Campbell SC. Infiltrative Renal Masses: Clinical Significance and Fidelity of Documentation. Eur Urol Oncol 2019; 4:264-273. [PMID: 31439434 DOI: 10.1016/j.euo.2019.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence of infiltrative renal masses (IRMs) and fidelity of documentation of infiltrative features remain unclear. OBJECTIVE To investigate the prevalence/significance of IRMs and assess whether infiltrative features were documented preoperatively. DESIGN, SETTING, AND PARTICIPANTS A total of 522 patients with renal tumors managed with partial/radical nephrectomy (2012-2014) whose pathology demonstrated locally advanced and/or aggressive histology were analyzed. Preoperative computed tomography/magnetic resonance imaging was retrospectively/independently reviewed by two radiologists. IRMs were required to have a poorly defined interface with parenchyma and nonelliptical shape in one or more distinct/unequivocal areas. Infiltrative features were defined as extensive or focal. INTERVENTION Partial/radical nephrectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer-specific mortality (CSM) was estimated using cumulative-incidence analysis. Significant and independent predictors of CSM were evaluated using Cox proportional hazard analysis. RESULTS AND LIMITATIONS Median tumor size was 6.9cm; renal cell carcinomas (RCCs) predominated (92%). Image review confirmed 133 IRMs (25%), including 103 RCCs; 59 had sarcomatoid or poorly differentiated features. IRMs were larger and more often symptomatic compared than non-IRMs, and disseminated disease was also more common for IRMs (all p<0.001). Overall, 109 IRMs were imaged at our center; 42 were documented as IRMs in preoperative radiology reports, while infiltrative features were not documented in 67 (61%). Only four (6%) of these 67 were documented as infiltrative by the surgical team. Infiltrative features were more often focal in undocumented IRMs. On multivariable analysis, infiltrative features, disseminated disease, and non-RCC histology were independent predictors of CSM (hazard ratio or HR [95% confidence interval {CI}]=1.73 [1.21-2.47], 2.98 [2.10-4.23], and 2.79 [1.86-4.62], respectively). Among IRMs, extensive infiltrative features and disseminated disease were associated with CSM (HR [95% CI]=1.98 [1.27-3.07] and 2.35 [1.52-3.63], respectively), while documentation status failed to show an association. Excluding patients with disseminated disease or residual cancer after surgery, recurrence rates were 62% for IRMs versus 22% for non-IRMs (p<0.001), and there was again no significant difference between documented and undocumented IRMs (p=0.36). Limitations include a retrospective design. CONCLUSIONS Twenty-five percent of locally advanced/histologically aggressive renal tumors exhibited infiltrative features, although many were not documented as IRMs. Among this high-risk surgical population, infiltrative features were independent predictors of CSM, irrespective of whether they were documented or not. Our data suggest that infiltrative features should be assessed and documented routinely during evaluation of renal masses. PATIENT SUMMARY Infiltrative renal masses may be more common than previously appreciated, although many were not documented as infiltrative during preoperative evaluation. Our data suggest that infiltrative features have a strong impact on prognosis and should be assessed and documented routinely during radiologic and clinical evaluation of renal masses.
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Affiliation(s)
- Hajime Tanaka
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Xiaobo Ding
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Yunlin Ye
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yanbo Wang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Molly E DeWitt-Foy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chalairat Suk-Ouichai
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ryan D Ward
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Honda Y, Nakamura Y, Teishima J, Goto K, Higaki T, Narita K, Akagi M, Terada H, Kaichi Y, Fujii S, Hayashi T, Matsubara A, Sentani K, Yasui W, Iida M, Awai K. Clinical staging of upper urinary tract urothelial carcinoma for T staging: Review and pictorial essay. Int J Urol 2019; 26:1024-1032. [PMID: 31379021 DOI: 10.1111/iju.14068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
Abstract
Upper urinary tract urothelial carcinoma is staged using the TNM classification of malignant tumors. Preoperative TNM is important for treatment planning. Computed tomography urography is now widely used for clinical survey of upper urinary tract carcinoma because of its diagnostic accuracy. Computed tomography urography is recommended as the first-line imaging procedure in several guidelines. Several reports stated that computed tomography urography is also useful for staging. However, no educational and practical reviews detailing the T staging of upper urinary tract urothelial carcinomas using imaging are available. We discuss the scanning protocol, T staging using computed tomography urography, limitations, magnetic resonance imaging, computed tomography comparison and pitfalls in imaging of upper urinary tract urothelial carcinoma. A recent study reported the high diagnostic accuracy of computed tomography urography with respect to T3 or higher stage tumors. To date, images that show a Tis-T2 stage have not been reported, but various studies are ongoing. Although magnetic resonance imaging has lower spatial resolution than computed tomography urography, magnetic resonance imaging can be carried out without radiation exposure or contrast agents. Magnetic resonance imaging also offers the unique ability of diffusion-weighted imaging without contrast agent use. Some researchers reported that diffusion-weighted imaging is useful not only for detecting lesions, but for predicting the T stage and tumor grade. We recommend the appropriate use of computed tomography and magnetic resonance while considering the limitations of each modality and the pitfalls in upper urinary tract urothelial carcinoma imaging.
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Affiliation(s)
- Yukiko Honda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Higaki
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keigo Narita
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motonori Akagi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Terada
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoko Kaichi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinsuke Fujii
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Wang Y, Tanaka H, Ye Y, Ding X, Ward RD, Campbell RA, DeWitt-Foy ME, Suk-Ouichai C, Remer EM, Campbell SC. The Complete Spectrum of Infiltrative Renal Masses: Clinical Characteristics and Prognostic Implications. Urology 2019; 130:86-92. [PMID: 31075276 DOI: 10.1016/j.urology.2019.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/23/2019] [Accepted: 04/27/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the full spectrum of patients presenting with radiologically-identified infiltrative renal masses (IRMs), including those managed surgically or otherwise, with focus on clinical presentation/prognosis. METHODS All 280 patients presenting with radiologically-identified renal mass with infiltrative features (2008-2017) were retrospectively reviewed. Poorly-defined interface between tumor and parenchyma and irregular shape (nonelliptical) in one or more distinct/unequivocal areas were required for classification as IRM. IRM was confirmed in 265 and clinical characteristics and outcomes were assessed. RESULTS Median age/tumor size were 65-years/6.9 cm, respectively, and 225 patients (85%) were R.E.N.A.L. = 10-12. Overall, 181 patients (68%) presented symptomatically, locally-advanced cancer (cT3-T4) was observed in 176 (66%) and disseminated disease and/or lymphadenopathy (>2 cm) in 181(68%). Clinical/radiographic findings were suggestive of etiology and could direct evaluation, but were nonspecific for definitive diagnosis. Renal-mass biopsy was performed in 103 patients and diagnostic in 97 (94%). Renal surgery was only performed in 82 patients (31%) and partial nephrectomy in 3 (1.1%). Overall, 72 patients (27%) received systemic chemotherapy and 59 (22%) targeted therapy. Final-diagnosis was renal cell carcinoma in 94 patients (35%), including 49 with highly-aggressive histology (sarcomatoid/rhabdoid/collecting-duct/medullary/unclassified). High-grade urothelial-carcinoma was found in 70 (26%), and lymphoma/metastatic cancer in 26 (10%)/25 (9%), respectively. Overall, 153 patients (58%) died; 138 (52%) cancer-related at median of 5 months. The majority of patients with renal cell carcinoma, urothelial-carcinoma, and renal metastasis died, almost exclusively cancer-related, at medians of 8, 3, and 2 months, respectively. CONCLUSION Our series includes the full spectrum of IRMs and confirms predominance of symptomatic, poorly-differentiated, highly-lethal malignancies. Our study highlights the overriding importance of identifying infiltrative features, a simple radiologic diagnosis, during assessment of renal masses.
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Affiliation(s)
- Yanbo Wang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Hajime Tanaka
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yunlin Ye
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaobo Ding
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Radiology, First Hospital of Jilin University, Changchun, China; Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan D Ward
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Molly E DeWitt-Foy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Chalairat Suk-Ouichai
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Erick M Remer
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Zeikus E, Sura G, Hindman N, Fielding JR. Tumors of Renal Collecting Systems, Renal Pelvis, and Ureters: Role of MR Imaging and MR Urography Versus Computed Tomography Urography. Magn Reson Imaging Clin N Am 2019; 27:15-32. [PMID: 30466909 DOI: 10.1016/j.mric.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematuria evaluation remains a common problem, particularly in patients who smoke and are at risk for urothelial tumors. Lifetime surveillance of the urothelium is often required once urothelial cancer is diagnosed. Computed tomography urography (CTU) has exquisite sensitivity and specificity for identification of renal and urothelial lesions. The examination is well accepted by patients and physicians. Possible harms include radiation exposure and contrast-induced nephropathy. MR imaging is also an accurate test, but requires longer exam times, and may not demonstrate stones. We present the technical and interpretation skills required to use MR urography and CTU effectively.
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Affiliation(s)
- Eric Zeikus
- UT Southwestern University Hospitals, 5323 Harry Hines Boulevard, Dallas, TX 75390-8827, USA.
| | - Giri Sura
- Abdominal Imaging Division, UT Southwestern University Hospitals, 5323 Harry Hines Boulevard, Dallas, TX 75390-8827, USA
| | - Nicole Hindman
- Department of Radiology, Abdominal Imaging Section, NYU Langone Health, 660 First Avenue, Third Floor, New York, NY 10016, USA
| | - Julia R Fielding
- Abdominal Imaging Division, UT Southwestern University Hospitals, 5323 Harry Hines Boulevard, Dallas, TX 75390-8827, USA
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18
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Ding X, Ma X, Jia Y, Li H, Wang Y. Intrarenal urothelial cancers confused as infiltrative renal masses: Report of 22 cases and literature review. Oncol Lett 2018; 16:1912-1916. [PMID: 30008883 PMCID: PMC6036454 DOI: 10.3892/ol.2018.8867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/22/2018] [Indexed: 12/13/2022] Open
Abstract
Distinguishing infiltrative renal masses (IRMs) from intrarenal urothelial cancers (IUCs) is critically important, but may be challenging for any radiologist or urologist. The present study aimed to summarize the clinical, imaging and pathological characteristics of IRM, which were postoperatively confirmed as IUC. The analysis was performed using the records of 22 patients who were preoperatively diagnosed with IRM but the results of percutaneous biopsies or postoperative pathological analyses led to diagnoses of urothelial cancers (UCs) from January 2011 to December 2017. The demographic data, computed tomography (CT) imaging features and pathological characteristics were evaluated. The present study also reviewed the literature concerning the IRM and IUC. The mean age of patients was 62 years and 86.4% of them were >55 years. The sex and tumor side distributions were equal. Hematuria and/or flank pain were observed in 86.4% of patients. All patients exhibited endophytic solid renal masses with unclear tumor boundaries on CT images. The kidneys of 81.8% of patients maintained their normal shape while mild alternations were observed in 18.2% of cases. A total of 81.8% of patients maintained the reniform shape and 18.2% exhibited mild contour change. Of all patients, all tumors exhibited less or equal attenuation on unenhanced CT images and they were mildlyimproved on enhanced CT. A total of 6 cases were confirmed by biopsy, when patients underwent laparoscopic nephroureterectomy instead of radical nephrectomy. The remaining 16 patients underwent laparoscopic nephrectomy but the postoperative pathological diagnoses revealed the presence of UCs. All postoperatively confirmed cancers were stages T3 and T4 (62.5 and 37.5%, respectively). UCs should be suspected in middle aged or elderly middle-elderly patients presenting renal masses with endophytic solid unclear tumor boundary on unenhanced and slightly enhanced CT images, accompanied with hematuria and/or flank pain. Preoperative biopsy is preferred for complicated cases.
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Affiliation(s)
- Xiaobo Ding
- Department of Radiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaobo Ma
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yatao Jia
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hongfei Li
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Katsinis B. A Challenging Case of Poorly Differentiated Transitional Cell Carcinoma of the Kidney. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318755687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When describing carcinomas, poorly differentiated defines how little the tumor tissue resembles the normal tissue it came from. The origin of these types of tumors cannot be determined by histological findings alone. Imaging findings and patient history play a strong role in determining the source of the patient’s cancer. Imaging features of urothelial cancer of the renal pelvicaliceal system can be challenging for any sonographer or radiologist. When tumors are hyperechoic relative to nearby renal parenchyma, they may be obscured by the surrounding hyperechoic renal sinus fat, causing these carcinomas to be difficult to detect regardless of whether they are well defined or poorly differentiated. This case study delves into the difficulty in sonographically imaging a poorly differentiated transitional cell carcinoma without sonographic evidence of a primary circumscribed mass.
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Ballard DH, De Alba L, Migliaro M, Previgliano CH, Sangster GP. CT imaging spectrum of infiltrative renal diseases. Abdom Radiol (NY) 2017; 42:2700-2709. [PMID: 28580537 DOI: 10.1007/s00261-017-1193-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most renal lesions replace the renal parenchyma as a focal space-occupying mass with borders distinguishing the mass from normal parenchyma. However, some renal lesions exhibit interstitial infiltration-a process that permeates the renal parenchyma by using the normal renal architecture for growth. These infiltrative lesions frequently show nonspecific patterns that lead to little or no contour deformity and have ill-defined borders on CT, making detection and diagnosis challenging. The purpose of this pictorial essay is to describe the CT imaging findings of various conditions that may manifest as infiltrative renal lesions.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Luis De Alba
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Matias Migliaro
- Department of Radiology, Hospital Santa Isabel de Hungria, 2854 Pedro del Castillo, Guaymallen, 5521, Mendoza, Argentina
| | - Carlos H Previgliano
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA.
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Calopedos RJS, March B, Latif E, Shin B, Chennapragada S, Ruthven S. Malignant masquerade: a rare case of urothelial carcinoma with squamous differentiation invading into the renal vein. ANZ J Surg 2017; 88:E845-E846. [PMID: 28295995 DOI: 10.1111/ans.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Brayden March
- Department of Urology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Edward Latif
- Department of Urology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Bronwyn Shin
- Department of Radiology, Gosford Hospital, Gosford, New South Wales, Australia
| | | | - Stephen Ruthven
- Department of Urology, Gosford Hospital, Gosford, New South Wales, Australia
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Diaz RR, Kwon JK, Lee JY, Nahm JH, Cho KS, Ham WS, Cho NH, Choi YD. Renal pelvic urothelial carcinoma with vena caval thrombus mimicking renal cell carcinoma. Korean J Urol 2014; 55:624-7. [PMID: 25237466 PMCID: PMC4165927 DOI: 10.4111/kju.2014.55.9.624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/08/2012] [Indexed: 11/18/2022] Open
Abstract
A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
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Affiliation(s)
- Richilda Red Diaz
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Kyou Kwon
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hae Nahm
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Urological Science Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Clinical Trials Center for Medical Devices, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Transitional cell carcinoma of the upper urinary tract: optimizing image interpretation with 3D reconstructions. ACTA ACUST UNITED AC 2013; 37:1129-40. [PMID: 22207253 DOI: 10.1007/s00261-011-9838-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This article reviews the pathophysiology of transitional cell carcinoma (TCC), CT urography (CTU) protocols, different possible 3D reconstruction techniques, and the importance of 3D reconstructions for appropriate interpretation. RESULTS/CONCLUSION CTU has largely replaced conventional IV pyelography in the evaluation of the upper urinary tract for TCC. The majority of large lesions can be easily seen on standard axial images with multiplanar reformats. However, it is imperative to also use 3D reconstructions when interpreting these studies, as subtle lesions can be difficult to visualize on the more traditional images. In this pictorial essay, we present multiple cases of upper urinary tract TCC which illustrate the value of 3D reconstructions for increasing the conspicuity of lesions, particularly at the junction of the infundibulum and calyx and in the ureters. As these cases demonstrate, each of the three possible 3D reconstruction techniques (maximum intensity projection, volume rendering, and volume rendered "virtual ureteroscopy") has its own distinct advantages, although the pitfalls of each technique must also be kept in mind.
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Xue LY, Lu Q, Huang BJ, Li CL, Yan CJ, Wen JX, Wang WP. Evaluation of renal urothelial carcinoma by contrast-enhanced ultrasonography. Eur J Radiol 2012; 82:e151-7. [PMID: 23228279 DOI: 10.1016/j.ejrad.2012.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/10/2012] [Accepted: 11/01/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE To observe ultrasonographic features of urothelial carcinoma in renal pelvis and evaluate contrast-enhanced ultrasound (CEUS) in diagnosis. MATERIALS AND METHODS Fifty-two patients with urothelial carcinoma underwent preoperative conventional US, colour Doppler flow imaging (CDFI) and CEUS. RESULTS Of 52 total lesions, 41 (78.8%) could be clearly identified by US, and 49 (94.2%) were enhanced by CEUS. Among US-imaged lesions, 39 (95.1%) were solid tumours, and two (4.9%) were mixed solid-cystic; 25 (61.0%) were isoechoic, 11 (26.8%) hypoechoic, and five (12.2%) hyperechoic. Analysis of tumour blood flow by CDFI characterised 17 avascular lesions (41.5% of total), 16 hypovascular (39.0%), and 8 hypervascular (19.5%). The resistance index ranged from 0.65 to 0.88 (mean of 0.71). Enhancement was seen in 49 lesions after injection of SonoVue. A slow enhancement pattern was observed in 36 lesions (73.5%) relative to renal cortex, and 13/49 (26.5%) showed simultaneous enhancement. At peak enhancement, 38 lesions (77.6%) were hypo-enhanced, six (12.2%) iso-enhanced, and five (10.2%) hyper-enhanced. There were 12 lesions with intertumoural necrosis or haemorrhage (24.5%) that were heterogeneously enhanced, and 37 (75.5%) were homogeneously enhanced. A fast washout pattern was observed in 46 lesions (93.9%), synchronous washout in two (4.08%), and slow washout in one (2.04%). CONCLUSIONS Slow-in, fast-out, and hypo-enhancement properties are associated with renal urothelial carcinoma and may thus have diagnostic value. We found that CEUS is able to identify tumours that are ambiguous by conventional US, and it thus significantly improves the confidence of diagnosis.
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Affiliation(s)
- Li-Yun Xue
- Shanghai Institute of Medical Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, Building 1#, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
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Hanzlicek AS, Ganta C, Myers CB, Grauer GF. Renal transitional-cell carcinoma in two cats with chronic kidney disease. J Feline Med Surg 2012; 14:280-4. [PMID: 22269336 PMCID: PMC10822514 DOI: 10.1177/1098612x12437119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Two 12-year-old cats were diagnosed with chronic kidney disease (CKD) based on physical examination, clinicopathologic data and, in one case, abdominal ultrasound findings. Approximately 1 year after the initial diagnosis of CKD both cats developed renal transitional cell carcinoma (TCC)--bilateral in one cat. Based on post-mortem examination, one cat had no evidence of metastasis and the other had metastasis to the large intestine, heart and lungs. This is the first report of de novo bilateral renal TCC in a cat, as well as the first report of renal TCC developing in cats with previous history of confirmed CKD.
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Affiliation(s)
- Andrew S Hanzlicek
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA.
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Centrally Infiltrating Renal Masses on CT: Differentiating Intrarenal Transitional Cell Carcinoma From Centrally Located Renal Cell Carcinoma. AJR Am J Roentgenol 2012; 198:846-53. [DOI: 10.2214/ajr.11.7376] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Current World Literature. Curr Opin Support Palliat Care 2011; 5:297-305. [DOI: 10.1097/spc.0b013e32834a76ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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