Ultrasound images of Transitional cell carcinoma

Transitional cell carcinoma is the most common bladder tumour, occurring less frequently in the collecting system of the kidney and the ureter. It usually presents with haematuria while still small. It is best diagnosed with cystoscopy. Small tumours in the collecting system are difficult to detect on ultrasound unless there is proximal dilatation. Depending on its location it may cause hydronephrosis, particularly if it is situated in the ureter (rare) or at the vesicoureteric junction (VUJ). IVU, retrograde cystography and CT are methods of diagnosis.
Situated within the collecting system of the kidney, the transitional cell tumour is usually small (compared to the RCC), homogeneous and relatively hypoechoic (Fig. A). Proximal renal tract dilatation may sometimes be present. These tumours are easy to miss on ultrasound unless the kidney is scanned very carefully, and often are, unless the case is highlighted by clinical symptoms or a high clinical index of suspicion. They can mimic a hypertrophied column of Bertin (see above); CT may differentiate in cases of doubt. Once large, they invade the surrounding renal parenchyma and become indistinguishable from RCC on ultrasound. They frequently spread to the bladder and the entire renal tract should be carefully examined.
In the bladder they are potentially easier to see as they are surrounded by urine. Invasion of the bladder wall can be identified on ultrasound in the larger ones but biopsy is necessary to determine formally the level of invasion IVU or a retrograde cystogram are the methods of choice for demonstrating a filling defect in the PCS (Fig. 7.11) or ureter; CT may be useful and is also used for staging purposes.
In such cases, the primary diagnosis is usually already known and other abdominal metastases, such as liver deposits and/or lymphadenopathy, are commonly seen on ultrasound. Rarely, a single metastasis is seen in the kidney without other evidence of metastatic spread, making the diagnosis difficult (as the question arises of whether this could be a primary or secondary lesion). CT may identify the primary and frequently picks up other, smaller metastases not identified on ultrasound.
FIG. A
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Ultrasound images Large, transitional cell carcinoma in the upper pole of the RK. The changes are more subtle than those of renal cell carcinoma, and the renal outline remains intact.
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ultrasound images of Transitional cell carcinoma in the bladder at the right vesicoureteric junction. Blood flow can clearly be seen within the tumour, and right renal and ureteric dilatation was present.
FIG. B
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ultrasound images IVU with multiple filling defects in the
relatively non-dilated PCS of the RK, which represent
transitional cell carcinomas.
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