Fifty-two cases of primary ureteral carcinoma: a clinical-pathologic study

Multiple ureteral diverticula: a possible radiographically demonstrable risk factor in development of transitional cell carcinoma

Six cases of multiple ureteral diverticula are reported. Most were associated with urinary tract obstruction or stasis and infection. One-third had transitional cell carcinoma, a frequency similar to that reported in previous series. These diverticula are a radiographically demonstrable reflection of urothelial hyperplasia/metaplasia and may represent a risk factor for development of transitional cell carcinoma.

Carcinoma of the renal pelvis and ureter following bladder carcinoma: frequency, risk factors and clinicopathological findings

We followed 657 primary bladder carcinoma patients for at least 10 years or until death. Subsequent carcinomas of the renal pelvis or ureter were found in 11 patients (1.7 per cent) 10 months to 13 years after the primary bladder tumor. In 3 patients the tumors were diagnosed or suspected by excretory urography, while in 5 the tumors were not found until autopsy. Four patients had undergone cystectomy and 9 had multiple bladder tumors at the initial assessment or during followup. The initial or recurrent bladder tumor involved the ipsilateral ureteral orifice in 6 patients. We conclude that in bladder cancer patients routine excretory urography is not indicated in the absence of upper urinary tract symptoms but it should be performed in selected patients, that is those with multiple and recurrent bladder tumors or tumors involving the ureteral orifices, or those with a previous cystectomy.

Multiple simultaneous bilateral urothelial tumours of the renal pelvis

Three cases of simultaneous bilateral transitional cell carcinoma of the renal pelvis are reported. In one case the bladder and urethra were also involved. The information provided by radiological studies (particularly renal angiography) and cytology allowed us to define with accuracy not only tumour sites but also the tumour itself and the degree of malignancy. Based on the latter finding, the surgical approach was adapted to each individual case and consisted of papillectomy, partial pyelectomy or heminephrectomy associated with contralateral nephroureterectomy. In one case total cystourethrectomy was performed. Long-term follow-up showed no recurrence in the residual urinary tract 5 to 8 years post-operatively.

Carcinoma of the ureter: natural history, management and 5-year survival

We reviewed retrospectively 53 new cases of primary ureteral carcinoma. Each patient was staged pathologically and survival by operative procedure was compared. Depth of tumor invasion is the most accurate indicator of over-all outcome. Patients with stage A tumors had an 80 per cent 5-year survival rate, compared to only 33.3 per cent of the patients with stage C lesions. Patients also were divided into 2 groups: group 1 patients had a ureteral lesion only, and group 2 patients had a ureteral tumor and a second primary urothelial lesion. No difference was found in 5-year survival rates for patients in groups 1 (48.3 per cent) and 2 (47.7 per cent). Since prognosis for patients with low stage tumors was not enhanced by an aggressive operation a more conservative approach is indicated.

The late results of conservative surgery for upper tract urothelial carcinomas

In a selected series of 14 patients, upper tract urothelial tumours were excised with preservation of the ipsilateral kidney. The 5-year survival rate was 83%. The ipsilateral local recurrence was 5/14 (36%) but in 4 cases salvage surgery was effective and in 2 cases a functioning kidney was still preserved. The results of conservative surgery and its indications are discussed.

Primary neoplasms of the ureter

The role of tobacco as a carcinogenic agent should be considered in ureteral carcinoma. In our study 77 per cent of the patients had a history of smoking, with an average of 50 packs a year consumption. Various studies have shown that the prognosis for ureteral carcinoma is related primarily to the grade and stage of the disease at the time of treatment. Therefore, it is imperative that the clinician maintain a high index of suspicion. This index of suspicion should be heightened in any patient with lower tract urothelial tumors. In addition to endoscopic followup excretory urography should be done on an annual basis, with retrograde studies when necessary. Ureteral brush biopsies or tissue obtained with the Dormia basket may be diagnostic. A Dormia stone basket was used in 3 patients in our study and sufficient tissue for diagnosis was obtained in each case. No complications were encountered. The results obtained in treating a primary leiomyosarcoma of the ureter are noteworthy in that complete remission of pulmonary metastases was obtained after the patient received a course of doxorubicin hydrochloride and dimethyl-triazeno imidazole carboxamide.

Primary carcinoma of ureter. Report of 27 new cases

A retrospective analysis of 27 cases of primary carcinoma of the ureter is presented. The ages of the patients ranged from forty-two to eighty-three years, with the highest incidence between the fifth and seventh decades. Males were more frequently affected than females, and the tumors were usually found in the lower third of the ureter. Hematuria and flank pain were the presenting symptoms in the majority of cases. Poorly differentiated invasive tumors had poor prognosis when compared to well-differentiated noninvasive lesions. Total nephroureterectomy with excision of bladder cuff is the preferred treatment for ureteral carcinoma in view of the high rate of ipsilateral tumor recurrence.

Tumours of the renal pelvis and ureter. Symptomatology, diagnosis, treatment and prognosis

Forty-two cases of tumour of the renal pelvis and/or ureter are presented. The primary tumour was in the renal pelvis in 25 cases and in the ureter in nine. A co-existent tumour elsewhere in the uroepithelium was found in 16 of these 34 patients. In the remaining eight patients, tumour of the urinary bladder was the initial diagnosis, but tumours of the upper urinary tract subsequently appeared. The principal symptom (38 of 42 cases) was haematuria, but flank pain and a mass in the kidney region also occurred. In most cases the diagnosis was indicated by the urograms and was confirmed by retrograde pyelography. Nephro-ureterectomy was done in most of the patients. The possibility that local tumour resection may be sufficient is briefly discussed. The tumours were classified as papillary in 24 patients and as solid in nine. There was no histologic classification in nine cases. The mean observation time was 29 months. Since new growths tend to arise at other sites in the uro-epithelium, follow-up examination should always include cystoscopy and urography. The prognosis was particularly poor in solid tumours: two-thirds of these patients died in the first postoperative year. Survival was clearly dependent on the tumour differentiation. High-grade tumours carried a poor prognosis.

The influence of retrograde contrast medium on urinary cytodiagnosis: a preliminary report

It has been recommended that before retrograde brushing of upper urinary tract lesions to diagnose malignancy the contrast medium should be washed away with saline because of possible cellular distortion. There were 21 paired specimens from 19 patients submitted for urinary cytodiagnosis. One specimen was a contrast medium wash, similar in pH and osmolality to urine, and the other a saline wash. Cellular detail was adequate for cytodiagnosis in 20 of the 21 contrast medium specimens. Of 7 specimens from patients with malignancy 3 were diagnosed correctly as malignant, 1 was classified as suspicious and 3 were falsely negative in the contrast wash group. Of the 3 falsely negative diagnoses 2 were changed to malignant when the paired saline wash specimens were examined. Urologists should not discard the contrast medium specimen prior to retrograde brushing but should send it along with a saline wash specimen for cytodiagnosis because the discarded contrast material and irrigant may have diagnostic cells.

Significance of urinary cytology in the early detection of transitional cell cancer of the upper urinary tract

Cytologic study of urine from 100 patients with transitional cell cancer of the upper urinary tract revealed that findings on the voided and catheterized specimens correlated well with grade and stage of the tumor. However, there was a significantly greater positive yield with urine specimens obtained by ureteral catheterization than by voiding. Consequently, because concomitant bladder tumors, diagnosed or not, can give questionable positive results ureteral catheterization specimens should be used for cytologic study.

Primary carcinoma of the ureter: a prognostic study

Fourty-one patients with primary invasive carcinomas of the ureter were seen at Memorial Hospital from 1947 to 1972. Overall survuval patterns were similiar in 19 patients with and 22 patients without prior or concomitant urothelial cancers elsewhere in the urinary tract, with 5-year survival rates, as estimated by the product-limit methos, of41% for both groups. Prognosis was determined primarily by anatomical stage of ureteral cancer. In 11 Stage A (submucosal) patients, 7 Stage B (muscular), 12 Stage C (periureteric fat), and 9Stage D (extraureteral), the similarly estimated 5-year survival rates were 91%, 43%, 23%, and nil, respectively. None of Stage A cases had metastases for periods ranging from 5 to 11 years after surgery alone. Seventy-eight percent of patients with more advanced stages died within 3 years of treatment, withmetastases mainly in pelvic and para-aortic lymph nodes.