CODE: 9.2 - Diagnose and treatment Transitional Cell Carcinoma of the Upper Urinary Tract TCC-UUT
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Tadeusz Fedus, Sławomir Szczygieł, Jacek Tereszkiewicz

Oddział Urologii Wojewódzkiego Szpitala Specjalistycznego w Rzeszowie

summary

Introduction. Upper urinary tract Transitional Cell Carcinoma is relatively rare. TCC accounts for less than 5% of all urothelial tumors. 2/3 cases are tumors of the renal pelvis and 1/3 of the ureter. Histopathologic features, etiology, progression are similar to those of transitional cell carcinoma of the bladder. polychronotropism: TCC-UUT and TCC of the bladder are coexistence almost in 25-75% cases.

Objectives. Evaluation of the usefulness urography and CT in diagnose, progression, and surgical management Transitional Cell Carcinoma of the Upper Urinary Tract TCC-UUT

Materials and methods. From July 1996 to December 2005 we treated 42pts due to TCC, at the age between 45 and 80 (30 men, 10 women). The most common clinical symptoms TCC-UUT: hematuria30 pts - 70%; lumbar region pain 12 pts - 30%; coexistence TCC of the bladder 9 pts - 22%. Most patients were diagnosed using: urography; CT; cystoscopy very rarely anterograde or retrograde pyelography, ureteroscopy, MRI, cytopathology of the urine. All TCC-UTT diagnosed patients were operated; we performed: Open Radical Nephroureterectomy with bladder cuff - 34; Nephroureterectomy without bladder cuff - 5; Partial resection of the ureter with tumor (end to end) - 1; Partial resection of the ureter with tumor (ureterocystoneostomy) - 1; Radical Nephroureterectomy with cystoprostatectomy with ureterocutaneostomy - 1

Results. Histopathology studies which were performed after the operation showed: 1. Transitional Cell Carcinoma of the renal pelvis - 27 pts, 62%. 2. Transitional Cell Carcinoma of the ureter - 9 pts, 22%. 3. Transitional Cell Carcinoma of the renal pelvis and ureter - 6 pts, 15%.

Conclusions. 1. Diagnosis in the TCC of the Upper Urinary Tract is still difficult. 2. The first diagnostic procedure which is performed at the beginning in evaluation of the urinary system is still urography. 3. Urography findings depend on pathomorphology form of the tumor, staging, but no one is specific, and no one could be sufficient to diagnose TCC of the Upper Urinary Tract. 4. All disturbing abnormalities should be estimated in CT with contrast. 5. CT with contrast is useful in both diagnosis and staging of upper tract urothelial tumors and let us plan surgical management. 6. Transitional cell cancers are usually relatively hypovascular (particularly compared with renal cell carcinoma), do not usually have marked enhancement after intravenous contrast injection, and distort the shape of the kidney relatively infrequently. 7. CT is more sensitive in the TCC of the renal pelvis than the TCC of the ureter, percentage of correct diagnosis is 80% in TCC of the renal pelvis and 60% in the TCC of the ureter. Additional instrumental studies like Ureteroscopy or Nephroscopy significantly increase sensitivity to the diagnosis. 8. When papillous form of TTC - UUT - ureter is affirmed in Urography, Computed Tomography and additional confirmed in Ureteroscopy, it is possible to perform uretero-saving-surgery with joint end to end. 9. Histopathology staging of the surgical specimen is similar to the result CT. 10. The number of correct diagnoses of the TCC-UUT, before surgical procedure, has been significantly increased during last years. It is possible thanks to spiral CT and 3D option. 11. In spite of more precise knowledge and imaging studies, we could not avoid some mistakes - 10% TCC-UUT is still diagnosed during surgical procedures.