Renal Transitional Cell Carcinoma Clinical Presentation

  • Author: Bagi RP Jana, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: May 8, 2012
 

History

Renal urothelial carcinoma (UC) is rarely reported as an incidental finding. Symptoms are significant enough to suggest the diagnosis in a relatively short time after disease development. A small percentage (1-2%) of patients are asymptomatic.

Gross hematuria is the most common presenting symptom, occurring in 75-95% of patients. Microscopic hematuria occurs in 3-11% of patients.

Approximately 14-37% of patients report pain. Pain is usually dull and is caused by the gradual obstruction of the collecting system. Renal colic also may occur with the passage of blood clots.

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Physical Examination

The physical examination usually is not informative or specific, especially in patients with early-stage disease. A palpable flank mass may be noted in fewer than 20% of patients. The classic clinical triad of hematuria, pain, and mass is also rare (15%) and is usually an indicator of advanced disease.

Patients with squamous cell carcinoma (SCC) usually present with advanced disease. Renal calculi are present in 14-50% of patients with SCC.

Primary adenocarcinoma of the renal pelvis accounts for fewer than 1% of upper urinary tract urothelial tumors. It is associated with chronic urolithiasis, hydronephrosis, and pyelonephritis. A metastatic lesion must be ruled out before a diagnosis of primary disease can be made.

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Contributor Information and Disclosures
Author

Bagi RP Jana, MD  Assistant Professor, University of Texas Medical Branch at Galveston

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, American Society of Clinical Oncology, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Coauthor(s)

Kush Sachdeva, MD  Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

Georgi Guruli, MD, PhD Consulting Staff, Department of Surgery, Division of Urology, University Hospital; Assistant Professor, Department of Surgery, Division of Urology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Wendy Hu, MD Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Badrinath R Konety, MD Associate Professor, Department of Urology, University of California, San Francisco, School of Medicine

Disclosure: Nothing to disclose.

Michael Perry, MD, MS, MACP Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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  14. Hsueh TY, Huang YH, Chiu AW, et al. A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. BJU Int. Oct 2004;94(6):798-801.

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  16. Ong AM, Bhayani SB, Pavlovich CP. Trocar site recurrence after laparoscopic nephroureterectomy. J Urol. Oct 2003;170(4 Pt 1):1301. [Medline].

 
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CT scan with contrast, vascular phase. Mass can be seen in left renal pelvis (black arrows). Patient underwent nephroureterectomy. Tumor was high-grade urothelial carcinoma invading subepithelial tissue (stage T1) and measuring 7.5 × 3.2 × 3 cm.
CT scan, delayed phase. Enhancing mass can be visualized in left renal pelvis (white arrows).
Retrograde pyelography. Filling defect can be seen in left renal pelvis and lower calyx (black arrows). Patient underwent left nephroureterectomy. Tumor was low-grade urothelial carcinoma measuring 2.5 × 2 × 1 cm.
Right retrograde pyelogram demonstrates large filling defect in midureter due to transitional cell carcinoma (large arrow). Note characteristic appearance of radiographic contrast material just distal to obstruction (small arrow), which gives rise to so-called goblet sign. Contrast is also visible beyond partially obstructed segment of ureter in renal pelvis and collecting system.
Pathology specimen shows urothelial tumor of renal pelvis (white arrows).
 
 
 
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