Transitional cell carcinoma of upper urinary tract vs. benign lesions: distinctive MSCT features

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Multidetector CT can differentiate upper urinary tract transitional cell carcinoma from benign lesions by analyzing enhancement patterns, lesion location, urinary tract induration, and wall thickening.

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This paper describes how transitional cell carcinoma (TCC) of the upper urinary tract can be recognized on CT urography, classifying tumors into papillary, infiltrating papillary, and diffusely infiltrating patterns, and comparing these with benign mimics. It reports that many TCCs show characteristic CT appearances but that several benign conditions can resemble specific TCC categories, including endometriosis and nephrogenic adenoma, mycetomas, malacoplakia, and inflammatory pseudotumor (similar to infiltrating papillary TCC), as well as complex/ passed urolithiasis, chronic obstruction with infection, atypical pyelonephritis, and tuberculosis (mimicking diffusely infiltrating TCC), with fibroepithelial polyp mimicking papillary TCC. Differential diagnosis is addressed using CT enhancement patterns, lesion location, urinary-tract induration, and the range of urinary wall thickening, with 3D reconstructed images considered useful. The paper notes this mimicry as a major diagnostic limitation requiring attention to these imaging signs. Relevance to endometriosis: endometriosis is explicitly listed as a benign lesion that can mimic infiltrating papillary TCC on CT, though the paper’s main focus is distinguishing upper urinary tract TCC from benign mimics using MSCT features.

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Abstract

The transitional cell carcinoma (TCC) of the upper urinary tract is relatively uncommon. The clinical presentation of TCCs and many other diseases of the upper urinary tract are nonspecific, and most of these lesions are usually necessary to be evaluated by computed tomography (CT) urography. CT appearances of TCCs can be classified as papillary, infiltrating papillary, and diffusely infiltrating tumor. Most TCCs of the upper urinary tract can be identified on the bases of characteristic CT appearances. However, some benign lesions may mimic different categories of TCCs and should be taken into account for differentiating diagnosis. These lesions include endometriosis, nephrogenic adenoma, mycetomas, malacoplakia, and inflammatory pseudotumor which are similar to infiltrating papillary TCCs; complex urolithiasis, passed stone of ureter and ureteropelvic junction, chronic ureteropelvic junction obstruction with superimposed infection, atypical pyelonephritis, and tuberculosis which mimic diffusely infiltrating TCCs, and fibroepithelial polyp which has the same CT appearances as papillary TCCs. The useful CT signs to make differential diagnosis involve enhanced pattern, location of lesion, induration of urinary tract, and range of thickening of urinary wall. The three-dimension (3D) reconstructed images is useful in making differential diagnosis.
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Abstract

The transitional cell carcinoma (TCC) of the upper urinary tract is relatively uncommon. The clinical presentation of TCCs and many other diseases of the upper urinary tract are nonspecific, and most of these lesions are usually necessary to be evaluated by computed tomography (CT) urography. CT appearances of TCCs can be classified as papillary, infiltrating papillary, and diffusely infiltrating tumor. Most TCCs of the upper urinary tract can be identified on the bases of characteristic CT appearances. However, some benign lesions may mimic different categories of TCCs and should be taken into account for differentiating diagnosis. These lesions include endometriosis, nephrogenic adenoma, mycetomas, malacoplakia, and inflammatory pseudotumor which are similar to infiltrating papillary TCCs; complex urolithiasis, passed stone of ureter and ureteropelvic junction, chronic ureteropelvic junction obstruction with superimposed infection, atypical pyelonephritis, and tuberculosis which mimic diffusely infiltrating TCCs, and fibroepithelial polyp which has the same CT appearances as papillary TCCs. The useful CT signs to make differential diagnosis involve enhanced pattern, location of lesion, induration of urinary tract, and range of thickening of urinary wall. The three-dimension (3D) reconstructed images is useful in making differential diagnosis. Similar content being viewed by others

References

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Condition tags

endometriosis

MeSH descriptors

Carcinoma, Transitional Cell Tomography, Spiral Computed Urologic Neoplasms Adult Aged Carcinoma, Transitional Cell Carcinoma, Transitional Cell Contrast Media Diagnosis, Differential Humans Imaging, Three-Dimensional Infant Male Middle Aged Neoplasm Staging Radiographic Image Interpretation, Computer-Assisted Tomography, Spiral Computed Urologic Neoplasms Urologic Neoplasms

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