Renal pelvis and ureteral tumors

Question 1

Most common type of upper tract carcinoma?

What are the other two most common types?

Answer 1

Transitional cell carcinoma (>95%)

Others are squamous cell carcinoma (associated with staghorn calculi, chronic infection/irritation) and adenocarcinoma

Question 2

Most common location of upper tract TCC?

Answer 2

Renal pelvis > ureter

Question 3

If TCC is in the ureter, is it more commonly distal, mid, or proximal?

Answer 3

Distal (70%) > mid (25%) > proximal (5%)

Question 4

Why does upper tract TCC usually present at higher grade than bladder cancer TCC?

Answer 4

thinner muscularis mucosa

Question 5

This specific type of tumor, if found in the bladder, has an increased risk of developing/finding upper tract TCC.

Answer 5

Inverted papilloma

Question 6

Upper tract TCC is more associated with bladder TCC or CIS?

Answer 6

CIS (20%); upper tract TCC is < 5% associated with bladder TCC

Question 7

Found in people who have been living in areas of Croatia, Bosnia and Herzegovina, Serbia, Romania, and Bulgaria, this condition causes renal failure and then and increased risk of upper tract TCC. Also, what is the chemical contaminant thought to be responsible for this condition?

Answer 7

Balkan endemic nephropathy.

Due to ingesting food contaminated with aristolochic acid ; seeds of the “European birthwort” which have this chemical get into the wheat bread there

*condition also seen in Chinese people using aristolochic acid containing herbs–“Chinese herbs nephropathy”

Question 8

Stage T1 upper tract TCC?

Answer 8

subepithelial CT

Question 9

Stage T2 upper tract TCC?

Answer 9

muscularis

Question 10

Stage T3 upper tract TCC?

Answer 10

surrounding fat or kidney

Question 11

Stage T4 upper tract TCC?

Answer 11

surrounding organs

Question 12

Lymph node drainage of renal pelvis?

Answer 12

renal hilar, paracaval, aortic, retroperitoneal

Question 13

Lymph node drainage or ureter?

Answer 13

renal hilar, iliac, paracaval, periureteral, pelvic

Question 14

Gold standard treatment of upper tract TCC?

Answer 14

Nephroureterectomy with bladder cuff

- tx of choice for high grade (T3), invasive, multifocal tumors

Question 15

How could you treat upper tract TCC in a pt with solitary kidney, poor surgical candidate, or if low grade/stage?

Answer 15

• endoscopic resection/ablation with holmium or Nd:YAG laser
• percutaneous approach if large (> 1.5cm) renal pelvis TCC thats grade 1-2
  • advantageous in that nephrostomy tubes can be used for BCG or Mitomycin antegrade infusion; however, 1/3 will recur

Question 16

Treatment of choice for distal ureteral TCC?

Answer 16

distal ureterectomy with ureteroneocystostomy

Question 17

treatment if muscle invasive?

Answer 17

MVAC or gemcitabine + cisplatin chemo

Question 18

How does ureteral endometriosis present?

Answer 18

cyclical pain and hematuria associated with menstruation and extrinsic hydronephrosis, although about 40% are silent

Question 19

Best imaging study for ureteral endometriosis?

Answer 19

MRI, but true diagnosis requires tissue

Question 20

Treatment for ureteral endometriosis

Answer 20

surgical resection with concomitant hysterectomy with bilateral salpingo-oophorectomy

• mild symptoms can be managed with gonadotropi-releasing hormone agonist (Leuprolide) or medroxyprogesterone

Question 21

These are benign ureteral tumors, usually found in the proximal left ureter of men, can cause UPJO and hematuria, and are easily removed with ureteroscopy most of the time

Answer 21

fibroepithelial polyps