Urothelial Cancer of the Upper Urinary Tract: Diagnostics and Features of the Disease Course

Yulia Stepanova 1 Saikhan Dunaev 2 Aleksander Teplov 3 Aleksander Gritskevich 3 Mariya Morozova 1 Dmitry Kalinin 4
1Radiology, A.V. Vishnevsky Institute of Surgery, Russia
2Radiology, Chechen State University, Russia
3Urology, A.V. Vishnevsky Institute of Surgery, Russia
4Pathology, A.V. Vishnevsky Institute of Surgery, Russia

PURPOSE: To analyze the results of diagnosis and treatment of the patients with urothelial cancer of the upper urinary tract.

Materials and methods. In A.V. Vishnevsky Institute of Surgery 214 patients with kidney tumors were treated during 2014-2017, morphologically verified urothelial carcinoma (study group) was identified in 11 (5.2%) patients, 4 women and 7 men, average age 64.21 years. Ultrasound, CT and MRI performed in the stages of surgical treatment of the patients.

RESULTS: In the retrospective assessment of the data, the primary pelvis lesion were revealed in 7 cases, ureter - 2, pelvis+ureter - 1, pelvis+bladder - 1. Right-sided lesion was diagnosed in 7 cases, left-sided lesion – 4. All the methods of investigation made it possible to diagnose the pathological process at pelvis lesion. At ureteral involvement in one case, when the tumor was localized in the upper third, all the methods allowed to verify the disease; in another, when the tumor was located in the lower third of the ureter, ultrasound only visualized the enlargement of the pelvis and ureter, however, the substrate that caused the enlargement couldn’t be visualized. MRI and contrast enhancement CT clearly differentiated the level and volume of lesion. At simultaneous pelvis and ureter lesions, ultrasound clearly differentiated pelvis tumor, suspicion of ureteral involvement was made on the basis of ureter dilatation, tumor couldn’t be visualized. In this case, CT and MRI made it possible to clearly differentiate both lesions. With simultaneous lesion of the pelvis and bladder, all methods of investigation allowed verifying both lesions. The progression of the process was diagnosed in 4 cases in postoperative period: ureteral tumors - 3 cases (1, 1 and 2); bladder tumor was subsequently diagnosed in one of them; bladder tumor - 1 case.

CONCLUSION: Tumors of the renal pelvis are more common than ureter tumors. Considering the possible multiple lesions of the pelvis, ureters, and bladder, when one of them is identified, it’s advisable to conduct a survey at all levels to avoid multiple lesions. Ultrasound can diagnose a tumor of the pelvis and ureter in the upper third, however, when detecting ureteral expansion in the middle third, other methods should be used. With a tumor size of more than 10.0 mm, CT and MRI are sufficient methods for verifying tumors at all lesion levels. Due to the fairly frequent progression of the disease, patients of this category should undergo a regular examination.

Yulia Stepanova
Yulia Stepanova