DOI: 10.1148/rg.256045517
Transitional Cell Carcinoma of the Upper Urinary Tract: Spectrum of Imaging Findings1
Ronan F. J. Browne, MB, BCh, MSc, FFRRCSI,
Conor P. Meehan, MB, BCh, MRCPI,
Jane Colville, MB, BCh,
Raymond Power, MB, BCh, FRCSI and
William C. Torreggiani, MB, BCh, MRCPI, FRCR, FFRRCSI
1 From the Departments of Radiology (R.F.J.B., C.P.M., J.C., W.C.T.) and Urology (R.P.), Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received March 30, 2004; revision requested May 12; final revision received April 21, 2005; accepted April 22. All authors have no financial relationships to disclose.
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Figure 1. TCC of the renal pelvis in a 60-year-old man with painless hematuria. Fifteen-minute EU image shows a large irregular filling defect (arrow) involving the right renal pelvis and extending into the lower pole caliceal system.
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Figure 2. TCC of the renal pelvis in a 65-year-old man. Fifteen-minute EU image shows a large stippled filling defect involving the collecting system of the right kidney (arrow).
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Figure 3. TCC of the upper pole collecting system in a 55-year-old woman. Fifteen-minute EU image shows amputation of the upper pole calix (arrow) secondary to TCC.
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Figure 4. Renal TCC in a 67-year-old woman. RP image shows a diffuse infiltrating TCC involving the right lower pole calix with irregularity of the involved mucosa (arrow).
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Figure 5. Renal TCC in a 67-year-old man with hematuria. RP image shows amputation of the upper pole calix due to TCC (straight arrow). Multiple calculi are also seen within the lower pole and interpolar calices (curved arrows).
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Figure 6. Ureteric TCC in a 62-year-old man. RP image shows an irregular stricture (arrow) with hydroureter proximal to the site of the tumor.
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Figure 7. Ureteric TCC in a 68-year-old woman. RP image shows a long irregular stricture of the left distal ureter with proximal hydronephrosis and "shouldering" (arrow).
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Figure 8. TCC of the pelviureteric junction in a 76-year-old man with painless hematuria. RP image shows concentric narrowing of the pelviureteric junction (arrow) with hydronephrosis. This appearance simulates benign disease but was shown to represent TCC at histologic analysis.
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Figure 9. Ureteric TCC in a 58-year-old man. RP image shows a duplex right collecting system. TCC in the midportion of the ureter draining the upper pole moiety produces the characteristic goblet sign (straight arrow). Another tumor is identified in the ureter draining the lower pole moiety (curved arrow).
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Figure 10. Renal TCC in a 59-year-old woman. Sagittal US scan shows a tumor (arrows) in the echogenic renal sinus. Tumor tissue is more echogenic than the surrounding renal cortex but less echogenic than renal sinus fat.
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Figure 11. Renal TCC in a 55-year-old man. Sagittal US scan of the left kidney shows a tumor in the upper pole (arrow).
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Figure 12. Renal TCC in a 65-year-old woman. Sagittal US scan shows a large mass of mixed echogenicity (arrows) involving the upper pole calix and overlying renal parenchyma. At histologic analysis, the mass was shown to represent high-grade TCC.
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Figure 13a. TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. (a) Axial nonenhanced CT scan shows a mass (arrow) in the right renal pelvis. The mass is slightly hyperattenuating relative to the urine and renal parenchyma. (b) Axial nephrographic phase CT scan shows that the mass (arrow) has characteristic early enhancement, which is less than that of the surrounding renal parenchyma. (c) Axial excretory phase CT scan shows the mass within the renal pelvis with surrounding excreted contrast medium. (d) Axial excretory phase CT scan (bone window) shows the lesion more clearly (arrow). (e) Coronal maximum intensity projection (MIP) image shows the tumor (arrow) in EU format. (f) Detail of a coronal MIP image shows the lesion more clearly (arrow).
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Figure 13b. TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. (a) Axial nonenhanced CT scan shows a mass (arrow) in the right renal pelvis. The mass is slightly hyperattenuating relative to the urine and renal parenchyma. (b) Axial nephrographic phase CT scan shows that the mass (arrow) has characteristic early enhancement, which is less than that of the surrounding renal parenchyma. (c) Axial excretory phase CT scan shows the mass within the renal pelvis with surrounding excreted contrast medium. (d) Axial excretory phase CT scan (bone window) shows the lesion more clearly (arrow). (e) Coronal maximum intensity projection (MIP) image shows the tumor (arrow) in EU format. (f) Detail of a coronal MIP image shows the lesion more clearly (arrow).
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Figure 13c. TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. (a) Axial nonenhanced CT scan shows a mass (arrow) in the right renal pelvis. The mass is slightly hyperattenuating relative to the urine and renal parenchyma. (b) Axial nephrographic phase CT scan shows that the mass (arrow) has characteristic early enhancement, which is less than that of the surrounding renal parenchyma. (c) Axial excretory phase CT scan shows the mass within the renal pelvis with surrounding excreted contrast medium. (d) Axial excretory phase CT scan (bone window) shows the lesion more clearly (arrow). (e) Coronal maximum intensity projection (MIP) image shows the tumor (arrow) in EU format. (f) Detail of a coronal MIP image shows the lesion more clearly (arrow).
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Figure 13d. TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. (a) Axial nonenhanced CT scan shows a mass (arrow) in the right renal pelvis. The mass is slightly hyperattenuating relative to the urine and renal parenchyma. (b) Axial nephrographic phase CT scan shows that the mass (arrow) has characteristic early enhancement, which is less than that of the surrounding renal parenchyma. (c) Axial excretory phase CT scan shows the mass within the renal pelvis with surrounding excreted contrast medium. (d) Axial excretory phase CT scan (bone window) shows the lesion more clearly (arrow). (e) Coronal maximum intensity projection (MIP) image shows the tumor (arrow) in EU format. (f) Detail of a coronal MIP image shows the lesion more clearly (arrow).
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Figure 13e. TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. (a) Axial nonenhanced CT scan shows a mass (arrow) in the right renal pelvis. The mass is slightly hyperattenuating relative to the urine and renal parenchyma. (b) Axial nephrographic phase CT scan shows that the mass (arrow) has characteristic early enhancement, which is less than that of the surrounding renal parenchyma. (c) Axial excretory phase CT scan shows the mass within the renal pelvis with surrounding excreted contrast medium. (d) Axial excretory phase CT scan (bone window) shows the lesion more clearly (arrow). (e) Coronal maximum intensity projection (MIP) image shows the tumor (arrow) in EU format. (f) Detail of a coronal MIP image shows the lesion more clearly (arrow).
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Figure 13f. TCC of the renal pelvis in a 43-year-old man with flank pain and hematuria. (a) Axial nonenhanced CT scan shows a mass (arrow) in the right renal pelvis. The mass is slightly hyperattenuating relative to the urine and renal parenchyma. (b) Axial nephrographic phase CT scan shows that the mass (arrow) has characteristic early enhancement, which is less than that of the surrounding renal parenchyma. (c) Axial excretory phase CT scan shows the mass within the renal pelvis with surrounding excreted contrast medium. (d) Axial excretory phase CT scan (bone window) shows the lesion more clearly (arrow). (e) Coronal maximum intensity projection (MIP) image shows the tumor (arrow) in EU format. (f) Detail of a coronal MIP image shows the lesion more clearly (arrow).
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Figure 14. TCC of the renal pelvis in a 66-year-old man with hematuria. Axial nephrographic phase CT scan shows a sessile filling defect (arrow), which is typical of renal pelvic TCC.
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Figure 15a. TCC of the upper renal pole in a 61-year-old woman. (a) Axial nonenhanced CT scan shows a mass (arrow) in the upper pole calix of the left kidney. (b) Axial nephrographic phase CT scan shows characteristic early enhancement of the tumor with extension into the surrounding upper pole parenchyma (arrow). (c) Axial excretory phase CT scan shows the diffuse tumor with a small amount of excreted contrast medium centrally (arrow). (d) Coronal MIP image shows the extent of the tumor (arrow) in EU format.
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Figure 15b. TCC of the upper renal pole in a 61-year-old woman. (a) Axial nonenhanced CT scan shows a mass (arrow) in the upper pole calix of the left kidney. (b) Axial nephrographic phase CT scan shows characteristic early enhancement of the tumor with extension into the surrounding upper pole parenchyma (arrow). (c) Axial excretory phase CT scan shows the diffuse tumor with a small amount of excreted contrast medium centrally (arrow). (d) Coronal MIP image shows the extent of the tumor (arrow) in EU format.
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Figure 15c. TCC of the upper renal pole in a 61-year-old woman. (a) Axial nonenhanced CT scan shows a mass (arrow) in the upper pole calix of the left kidney. (b) Axial nephrographic phase CT scan shows characteristic early enhancement of the tumor with extension into the surrounding upper pole parenchyma (arrow). (c) Axial excretory phase CT scan shows the diffuse tumor with a small amount of excreted contrast medium centrally (arrow). (d) Coronal MIP image shows the extent of the tumor (arrow) in EU format.
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Figure 15d. TCC of the upper renal pole in a 61-year-old woman. (a) Axial nonenhanced CT scan shows a mass (arrow) in the upper pole calix of the left kidney. (b) Axial nephrographic phase CT scan shows characteristic early enhancement of the tumor with extension into the surrounding upper pole parenchyma (arrow). (c) Axial excretory phase CT scan shows the diffuse tumor with a small amount of excreted contrast medium centrally (arrow). (d) Coronal MIP image shows the extent of the tumor (arrow) in EU format.
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Figure 16. Renal TCC in a 54-year-old man. Axial excretory phase CT scan shows TCC expanding centrifugally from the right renal pelvis. Note the parenchymal invasion with a delay in the cortical nephrogram (arrow).
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Figure 17. Renal TCC in a 53-year-old man. Axial nephrographic phase CT scan shows diffuse tumor infiltration of the left kidney with preservation of its reniform contour.
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Figure 18. Renal and ureteric TCC in a 76-year-old woman with gross hematuria and flank pain. Axial nephrographic phase CT scan shows extensive involvement of the left kidney and proximal ureter with TCC and perinephric extension of the tumor (arrow). Note the preservation of the reniform contour.
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Figure 19. Ureteric TCC in a 62-year-old man with right flank pain. Axial nephrographic phase CT scan shows enhancing TCC in the wall of the right ureter (arrow) with periureteric stranding and tumor extension.
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Figure 20a. Bilateral ureteric TCC in a 57-year-old woman. (a, b) Coronal T2-weighted MR images (repetition time msec/echo time msec = 1655/99.6) show low-signal-intensity tumors in the distal right (arrow in a) and distal left (arrow in b) ureters. Note the high-signal-intensity urine surrounding the tumors. (c) Axial gadolinium-enhanced T1-weighted MR image (616.7/ 10) obtained with fat saturation shows enhancement of the right ureteric tumor (large arrow). Note the gadolinium contrast material in the left ureter (small arrow) above the tumor.
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Figure 20b. Bilateral ureteric TCC in a 57-year-old woman. (a, b) Coronal T2-weighted MR images (repetition time msec/echo time msec = 1655/99.6) show low-signal-intensity tumors in the distal right (arrow in a) and distal left (arrow in b) ureters. Note the high-signal-intensity urine surrounding the tumors. (c) Axial gadolinium-enhanced T1-weighted MR image (616.7/ 10) obtained with fat saturation shows enhancement of the right ureteric tumor (large arrow). Note the gadolinium contrast material in the left ureter (small arrow) above the tumor.
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Figure 20c. Bilateral ureteric TCC in a 57-year-old woman. (a, b) Coronal T2-weighted MR images (repetition time msec/echo time msec = 1655/99.6) show low-signal-intensity tumors in the distal right (arrow in a) and distal left (arrow in b) ureters. Note the high-signal-intensity urine surrounding the tumors. (c) Axial gadolinium-enhanced T1-weighted MR image (616.7/ 10) obtained with fat saturation shows enhancement of the right ureteric tumor (large arrow). Note the gadolinium contrast material in the left ureter (small arrow) above the tumor.
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Figure 21a. Renal TCC in a 68-year-old woman. (a, b) Nephrographic phase (a) and excretory phase (b) coronal gadolinium-enhanced 3D fast low-angle shot source MR angiograms (3.64/1.37) show a moderately enhancing TCC (arrow) in the upper pole of the right kidney. (c) Gadolinium-enhanced 3D MIP MR angiogram shows the tumor more clearly. Note the retroaortic segment of the left renal vein.
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Figure 21b. Renal TCC in a 68-year-old woman. (a, b) Nephrographic phase (a) and excretory phase (b) coronal gadolinium-enhanced 3D fast low-angle shot source MR angiograms (3.64/1.37) show a moderately enhancing TCC (arrow) in the upper pole of the right kidney. (c) Gadolinium-enhanced 3D MIP MR angiogram shows the tumor more clearly. Note the retroaortic segment of the left renal vein.
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Figure 21c. Renal TCC in a 68-year-old woman. (a, b) Nephrographic phase (a) and excretory phase (b) coronal gadolinium-enhanced 3D fast low-angle shot source MR angiograms (3.64/1.37) show a moderately enhancing TCC (arrow) in the upper pole of the right kidney. (c) Gadolinium-enhanced 3D MIP MR angiogram shows the tumor more clearly. Note the retroaortic segment of the left renal vein.
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Figure 22. Bilateral renal TCC in a 77-year-old man with hematuria. Axial T2-weighted fast spin-echo MR image (8000/104) obtained with fat saturation shows TCC in the upper poles of both kidneys (arrows) with invasion of the right renal vein and inferior vena cava (arrowhead).
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Figure 23a. TCC of the renal pelvis in a 65-year-old man. Coronal (a) and sagittal (b) heavily T2-weighted (half-Fourier rapid acquisition with relaxation enhancement) source MR urograms (1500/116) show focal hydronephrosis and irregularity of the upper pole and interpolar calices of the right kidney (arrow).
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Figure 23b. TCC of the renal pelvis in a 65-year-old man. Coronal (a) and sagittal (b) heavily T2-weighted (half-Fourier rapid acquisition with relaxation enhancement) source MR urograms (1500/116) show focal hydronephrosis and irregularity of the upper pole and interpolar calices of the right kidney (arrow).
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Figure 24. Ureteric TCC in a 56-year-old woman. Coronal MIP half-Fourier rapid acquisition with relaxation enhancement MR urogram (1500/116) shows hydronephrosis and a filling defect due to a tumor in the mid left ureter (arrow). Note the poor demonstration of the nondilated right collecting system.
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Figure 25a. Ureteric TCC in a 68-year-old man with hematuria. (a) Coronal gadolinium-enhanced 3D fast low-angle shot MR urogram (3.64/1.37) obtained at 15 minutes shows hydronephrosis and proximal hydroureter to the level of the mid ureter. An enhancing tumor is seen in the ureteric wall at this level (thick arrow). No gadolinium contrast material is seen in the left collecting system. Deep vein thrombosis of the left femoral vein is incidentally noted (thin arrow). (b) Coronal gadolinium-enhanced 3D fast low-angle shot MR urogram (3.64/1.37) obtained at 2 hours shows the site of ureteric obstruction due to TCC (arrow).
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Figure 25b. Ureteric TCC in a 68-year-old man with hematuria. (a) Coronal gadolinium-enhanced 3D fast low-angle shot MR urogram (3.64/1.37) obtained at 15 minutes shows hydronephrosis and proximal hydroureter to the level of the mid ureter. An enhancing tumor is seen in the ureteric wall at this level (thick arrow). No gadolinium contrast material is seen in the left collecting system. Deep vein thrombosis of the left femoral vein is incidentally noted (thin arrow). (b) Coronal gadolinium-enhanced 3D fast low-angle shot MR urogram (3.64/1.37) obtained at 2 hours shows the site of ureteric obstruction due to TCC (arrow).
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Copyright © 2005 by the Radiological Society of North America.
