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UROEPITHELIAL TUMORS PowerPoint Presentation

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Description : This medical presentation on cancer titled "UROEPITHELIAL TUMORS" talks about urothelial carcinoma (transitional cell carcinoma - TCC), is by far the most common type of bladder cancer.

Tags : Cancer, URINARY BLADDER, RENAL PELVIS, URETER, RENAL CELL CARCINOMA OF KIDNEY, risk factors, UROEPITHELIAL TUMORS, urothelial carcinoma, transitional cell carcinoma, TCC, type of bladder cancer

Published on : Apr 28, 2021 | Views : 2861 | Downloads : 11

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Slide 1-

UROEPITHELIAL TUMORS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY LOYOLA UNIVERSITY MEDICAL CENTER
Slide 2-

UROEPITHELIAL TUMORS INCIDENCE URINARY BLADDER (94% OF ALL UROEPITHELIAL TUMORS) RENAL PELVIS (5% OF ALL UROTHELIAL TUMORS) URETER (1% OF ALL UROTHELIAL TUMORS)
Slide 3-

UROEPITHELIAL TUMORS INCIDENCE URINARY BLADDER (50 THOUSAND NEW CASES BLADDER CA/YEAR IN USA) M:F 3:1 RENAL CELL CARCINOMA OF KIDNEY (15,000 THOUSAND NEW CASES/YEAR IN USA)
Slide 4-

UROEPITHELIAL TUMORS RISK FACTORS SMOKING ANALGESICS PHENACETIN CYCLOPHOSPHAMIDE OCCUPATIONAL CARCINOGENS COAL, ASPHALT, TAR, PETROCHEMICALS, PLASTICS PAPILLARY NECROSIS FAMILIAL CANCER SYNDROMES HEREDITARY NONPOLYPOSIS COLORECTAL CANCER (LYNCH II)
Slide 5-

UROEPITHELIAL TUMORS COLLECTING SYSTEM DEVELOPES FROM FETAL MESONEPHROS UROEPITHELIAL CA: TRANSITIONAL CELL OR SQUAMOUS CARCINOMA DERIVED FROM MESODERM EPITHELIAL TISSUE RENAL PARENCHYMA DEVELOPES FROM METANEPHRIC BLASTEMA RENAL CELL CA: ADENOCARCINOMA DERIVED FROM TUBULAR EPITHELIUM
Slide 6-

UROEPITHELIAL TUMORS 90% TRANSITIONAL CELL 9% SQUAMOUS CELL >1% ADENOCARCINOMA SARCOMA UNDIFFERENTIATED BENIGN MESODERMAL
Slide 7-

UROEPITHELIAL TUMOR TRANSITIONAL, SQUAMOUS, AND SARCOMA ELEMENTS
Slide 8-

TRANSITIONAL CELL CARCINOMA
Slide 9-

TRANSITIONAL CELL CARCINOMA CLASSIFICATION PAPILLARY NONPAPILLARY
Slide 10-

TRANSITIONAL CELL CARCINOMA PAPILLARY TYPE 80% 50% ARE INFILTRATIVE MALIGNANCIES NONPAPILLARY TYPE 20% ALL CONSIDERED TO BE MALIGNANT
Slide 11-

PAPILLARY CARCINOMA INVASIVE VERSUS NONINVASIVE
Slide 12-

NONPAPILLARY (FLAT) CARCINOMA INVASIVE VERSUS NONINVASIVE
Slide 13-

TRANSITIONAL CELL TUMORS PATHOLOGIC CLASSIFICATION RANGE WELL DIFFERENTIATED PAPILLOMA (GRADE 1) MALIGNANCY RANGES FROM LOW-GRADE AND SUPERFICIAL TO HIGH-GRADE AND INVASIVE
Slide 14-

UROEPITHELIAL TUMORS IMAGING MODALITIES EXCRETORY UROGRAM SONOGRAPHY RETROGRADE PYELOGRAM COMPUTED TOMOGRAPHY ANGIOGRAPHY
Slide 15-

TRANSITIONAL CELL TUMORS GROSS APPEARANCE ON IMAGING STUDIES SINGLE LESION SMALL AND PAPILLARY TO BULKY AND SESSILE MULTIPLE DISCRETE LESIONS DIFFUSE AND CONFLUENT LESIONS
Slide 16-

TRANSITIONAL CARCINOMA RENAL PELVIS
Slide 17-

UROEPITHELIAL TUMORS PAPILLARY TYPE STIPPLED APPEARANCE
Slide 18-

TRANSITIONAL CELL CA PAPILLARY TYPE STIPPLED APPEARANCE
Slide 19-

TRANSITIONAL CELL CARCINOMA TENDENCY TO BE MULTICENTRIC AND BILATERAL BILATERAL IN UP TO 10% OF PATIENTS (SYNCHRONOUS OR METACHRONOUS) UP TO 1/2 OF PATIENTS WITH CA URETER OR PELVIS WILL DEVELOP BLADDER CARCINOMA
Slide 20-

MULTIPLE TRANSITIONAL CELL CARCINOMAS
Slide 21-

TRANSITIONAL CELL CARCINOMA PROGNOSIS PATIENTS WITH A RENAL PELVIC PAPILLOMA 1/4 WILL DEVELOP A CARCINOMA PATIENTS WITH MULTIPLE PAPILLOMAS 1/2 WILL DEVELOP A CARCINOMA PATIENTS WITH BLADDER/URETER TRANSITIONAL NEOPLASM 1/3 ALREADY HAVE ANOTHER BLADDER TCC
Slide 22-

SQUAMOUS CARCINOMA
Slide 23-

SQUAMOUS TUMORS ASSOCIATED WITH INFECTION AND STONES, LEUKOPLAKIA SQUAMOUS METAPLASIA OF TRANSITIONAL EPITHELIUM MOST ARE SOLITARY CAN BE PAPILLARY OR SESSILE HIGHLY INVASIVE OVERALL, POOR PROGNOSIS
Slide 24-

HEMATURIA SQUAMOUS CARCINOMA INITIAL CT CT 8 MONTHS LATER
Slide 25-

SQUAMOUS TUMORS DIFFICULT TO RECOGNIZE DUE TO UNDERLYING DISEASE INFECTION STONES OFTEN INVASIVE OR METASTATIC AT TIME OF DIAGNOSIS PREDOMINENTLY EXTRALUMINAL MAY APPEAR AS URETERAL STRICTURE
Slide 26-

DISTAL URETERAL UROEPITHELIAL TUMOR SQUAMOUS CARCINOMA
Slide 27-

UROEPITHELIAL NEOPLASMS IMAGING
Slide 28-

UROEPITHELIAL TUMORS IMAGING COLLECTING SYSTEM CALYCES INFUNDIBULI PELVIS URETERS BLADDER
Slide 29-

UROEPITHELIAL TUMORS RENAL PELVIS
Slide 30-

TRANSITIONAL CELL CARCINOMA INVADES KIDNEY
Slide 31-

LARGE, INVASIVE UROEPITHEAL TUMOR RENAL PELVIS
Slide 32-

TRANSITIONAL CELL CARCINOMA RENAL PELVIS
Slide 33-

HEMATURIA INITIAL IVP TWO RETROGRADES IVP 1YEAR LATER
Slide 34-

NONFUNCTIONING KIDNEY
Slide 35-

TRANSITIONAL CELL CA PAPILLARY TYPE STIPPLED APPEARANCE
Slide 36-

RENAL SINUS FAT, OPACIFIED CALYX, TUMOR
Slide 37-

48-YEAR-OLD WOMAN PERSISTENT ABDOMINAL PAIN CT ONE YEAR LATER
Slide 38-

CT 10 mm VERSUS 5 mm COLLIMATION
Slide 39-

TRANSITIONAL CELL CA PELVIS CT AND ANGIOGRAPHY
Slide 40-

UROEPITHELIAL TUMORS CALYCES
Slide 41-

TRANSITIONAL CELL CA IVP RETROGRADE CT
Slide 42-

TRANSITIONAL CELL CA LOWER POLE CALYX
Slide 43-

TRANSITIONAL CELL CARCINOMA CT, IVP, RETROGRADE PYELOGRAM
Slide 44-

TRANSITIONAL CELL CARCINOMA DILATED CALYX IVP RETROGRADE
Slide 45-

TRANSITIONAL CELL CA AMPUTATED CALYX
Slide 46-

HEMATURIA 70/M IVP CT 1 YEAR LATER
Slide 47-

TRANSITIONAL CELL CARCINOMA PAPILLARY TYPE WITH STIPPLING
Slide 48-

TRANSITIONAL CELL CA SUBTLE
Slide 49-

UROEPITHELIAL TUMORS URETER
Slide 50-

GROSS HEMATURIA DISTAL URETERAL CA
Slide 51-

UROEPITHELIAL TUMORS BERGMAN SIGN (RETROGRADE PYELOGRAM) GOBLET SIGN (EXCRETORY UROGRAM)
Slide 52-

TRANSITONAL CARCINOMA OF URETER BERGMAN SIGN
Slide 53-

HEMATURIA 52-YEAR-OLD MAN IVP IVP 1YEAR LATER
Slide 54-

TRANSITIONAL CELL CARCINOMA IRREGULAR DISTAL URETER STRICTURE
Slide 55-

TRANSITIONAL CELL CA URETER IVP RETROGRADE
Slide 56-

VOLUMINOUS RENAL PELVIS 84-YEAR-OLD WOMAN
Slide 57-

ATROPHIC KIDNEY DISTAL URETERAL TUMOR
Slide 58-

ATROPHIC KIDNEY DISTAL URETER TRANSITIONAL CELL CA
Slide 59-

ATROPHIC KIDNEY DISTAL URETER TRANSITIONAL CELL CA
Slide 60-

PSEUDOURETEROCELE VERSUS SIMPLE URETEROCELE
Slide 61-

UROEPITHELIAL TUMORS BLADDER
Slide 62-

URINARY BLADDER CARCINOMA M:F- 4:1 MOST COMMON AFTER 5TH DECADE OF LIFE 12,000 DEATHS AND 50,OOO NEW CASES ANNUALLY MEN 4TH LEADING, WOMEN 10TH LEADING CAUSE OF DEATH EXCRETORY UROGRAPHY INSENSITIVE FOR DIAGNOSIS BUT OPTIMIZE TECHNIQUE AND SCRUTINIZE BLADDER CYSTOSCOPY
Slide 63-

TRANSTIONAL CELL CARCINOMA BLADDER
Slide 64-

URINARY BLADDER HALO SIGN
Slide 65-

BOWEL GAS ETCHED IN WHITE NEOPLASM WITH NO WHITE HALO
Slide 66-

URINARY BLADDER CARCINOMA
Slide 67-

WHAT ABNORMALITIES ARE DEMONSTRATED ON THIS IVP
Slide 68-

UROEPITHELIAL TUMORS TUMOR CALCIFICATION TRANSITIONAL CELL CARCINOMA SQUAMOUS CARCINOMA URACHAL CARCINOMA
Slide 69-

SQUAMOUS BLADDER CA CALCIFIED
Slide 70-

URACHAL CARCINOMA SQUAMOUS CARCINOMA
Slide 71-

CYTITIS GLANDULARIS WITH PELVIC LIPOMATOSIS
Slide 72-

URETHRA
Slide 73-

TWO MEN WITH HEMATURIA LITTRE GLANDS TRANSITIONAL CA
Slide 74-

UROEPITHELIAL NEOPLAMS STAGING
Slide 75-

UROEPITHELIAL NEOPLAMS TNM STAGING T1 INVASION OF SUBEPITHELIAL CONNECTIVE TISSUE T2 INVASION OF MUSCULARIS T3 INVASION THRU MUSCULARIS INTO PERIPELVIC FAT OR KIDNEY PARENCHYMA BY PELVIC LESION INVASION OF PERIURETERIC FAT BY URETERAL LESION T4 INVASION INTO PERINEPHRIC FAT OR ADJACENT ORGANS N M
Slide 76-

UROEPITHELIAL NEOPLAMS TNM STAGING T1 AND T2 (INVASION OF MUSCULARIS) T1 AND T2 OFTEN NOT DIFFERENTIATED BY IMAGING STUDIES T3 INVASION THRU MUSCULARIS INTO PERIPELVIC FAT OR KIDNEY PARENCHYMA BY PELVIC LESION INVASION OF PERIURETERIC FAT BY URETERAL LESION INFILTRATION OF FAT NOT SPECIFIC FOR TUMOR INVASION T4 INVASION INTO PERINEPHRIC FAT OR ADJACENT ORGANS TUMOR ABUTTING BUT NOT INVADING MAY NOT BE DIFFERENTIATED BY IMAGING STUDIES N FALSE POSITIVE AND FALSE NEGATIVE LYMPH NODES LARGE NODES WITHOUT TUMOR AND SMALL NODES WITH TUMOR
Slide 77-

INVASION OF THE RENAL VEIN RENAL CELL CARCINOMA RENAL PELVIS TRANSITIONAL CELL CA ANGIOMYOLIPOMA
Slide 78-

TRANSITIONAL CELL CARCINOMA INVADES KIDNEY
Slide 79-

HEMATURIA 57/M INITIAL CT IVP & CT 9 MONTHS LATER
Slide 80-

UROEPITHELIAL TUMOR STAGE 4
Slide 81-

EXTENSIVE UROEPITHELIAL TUMOR
Slide 82-

UROEPITHELIAL TUMORS METASTASES
Slide 83-

D.D. OF A FILLING DEFECT COLLECTING SYSTEM OR URETER STONE BLOOD CLOT NEOPLASM GAS BUBBLE CROSSING VESSEL PERISTALSIS PYELITIS / URETERITIS CYSTICA INFECTION / NECROTIC DEBRIS FUNGUS BALL LEUKOPLAKIA, MALAKOPLAKIA SLOUGHED PAPILLA, ABERRANT PAPILLA
Slide 84-

URETEROPELVIC FILLING DEFECT
Slide 85-

STONES
Slide 86-

GROSS HEMATURIA URETERAL STONE
Slide 87-

GROSS HEMATURIA STIPPLED URETERAL LESION
Slide 88-

DETECTION OF STONES EXCRETORY UROGRAM DETECTS 75% OF ALL CALCULI CT DECTECTS >98% OF ALL CALCULI SONOGRAPHY SENSTIVE FOR RENAL PELVIS AND PROXIMAL URETERAL CALCULI INSENSTIVE FOR DISTAL URETERAL CALCULI
Slide 89-

RENAL STONE SONOGRAPHY
Slide 90-

HEMATURIA CT WITH IV CONTRAST
Slide 91-

GROSS HEMATURIA
Slide 92-

BLOOD CLOT DIAGNOSIS OF HEMATOMAS RADIOGRAPHS AND EXCRETORY UROGRAMS NONSPECIFIC MASS EFFECT COMPUTED TOMOGRAPY ACUTE HEMORRHAGE HAS HIGH ATTENUATION LATER, HEMATOMA APPEARS AS LOW DENSITY CYST MAGNETIC RESONANCE IMAGING MOST SENSITIVE FOR DIAGNOSING HEMATOMA IN ACUTE, INTERMEDIATE, AND LATE STAGES OF EVOLUTION
Slide 93-

HISTORY OF UROEPITHELIAL MALIGNANCIES NOW HAS HEMATURIA
Slide 94-

BLOOD VESSEL CROSSING PELVIS
Slide 95-

CROSSING BLOOD VESSELS EXCRETORY UROGRAM SMOOTH FILLING DEFECT PERIPHERAL IF VIEW IN PROFILE CENTRAL IF VIEWED ENFACE INCONSTANT SHAPE CONFIRM DIAGNOSIS CT ANGIO MR ANGIO
Slide 96-

PYELITIS CYSTICA
Slide 97-

URETERITIS, PYELITIS CYSTICA SUBEPITHELIAL FLUID CONTAINING CYSTS USUALLY SMALL BUT RANGE FROM 1-20 MM ASSOCIATED WITH CHRONIC INFECTION PERSISTENT OR PERMANENT MAY BE ASSOCIATED WITH CYSTITIS CYSTICA
Slide 98-

URETERITIS CYSTICA
Slide 99-

IMMUNE SUPPRESSED PATIENT TRANSPLANTED KIDNEY INFECTED URINE
Slide 100-

URINARY TRACT INFECTION FUNGAL INFECTION HISTORY OF PATIENT SHOULD BE OBTAINED BACTERIAL URINARY TRACT INFECTIONS CAN PRODUCE DEBRIS CAUSING FILLING DEFECTS. FUNGAL INFECTION CAN PRODUCE FUNGUS BALLS CANDIDA ALBICANS MOST COMMON IMMUNOCOMPRIMISED OR DEBILITATED PATIENTS
Slide 101-

LEUKOPLAKIA
Slide 102-

LEUKOPLAKIA SQUAMOUS METAPLASIA OF TRANSITIONAL CELLS WITH PROLIFERATION & ATYPIA OF SQUAMOUS EPITHELIAL LAYER………PREMALIGNANT CHOLESTEATOMA……..MASS OF SHED MATRIAL IMAGING OF PYELOCALYCEAL SYSTEM AND URETER FOCAL OR WIDESPREAD IRREGULAR MARGINS IRREGULAR INTRALUMINAL MASS STONE DISEASE IN 1/2 CHRONIC INFECTION IS COMMON CARCINOMA IN UP TO 1/4
Slide 103-

MALAKOPLAKIA
Slide 104-

MALAKOPLAKIA OF BLADDER MICHAELIS-GUTMANN BODIES
Slide 105-

MALAKOPLAKIA GRANULOMATOUS RESPONSE TO E. COLI INFECTION MACROPHAGES CONTAIN CYTOPLASMIC INCLUSION BODIES CALLED MICHAELIS-GUTMANN BODIES AFFECTS ARE PART OF GU TRACT, BUT MOST COMMON IN BLADDER IMAGING SHOWS MULTIPLE IRREGULAR FILLING DEFECTS LOWER URINARY TRACT….GOOD PROGNOSIS DIFFUSE, MULTIFOCAL OR RENAL TX PATIENT…. POOR PROGNOSIS NO MALIGNANT POTENTIAL
Slide 106-

PAPILLARY NECROSIS
Slide 107-

PAPILLARY NECROSIS EXCRETORY UROGRAM AND RETROGRADE PYELOGRAM EARLY: SMALL, IRREGULAR COLLECTIONS OF CONTRAST IN PAPILLAE LATE: IRREGULAR DILATION OF CALYCES FILLING DEFECTS SLOUGHED PAPILLA IN CALYX, RENAL PELVIS, OR URETER SLOUGHED PAPILLAE THAT CALCIFY HAVE PERIPHERAL CALCIFICATION….DIFFERENT THAN STONES THE CONTOUR OF THE KIDNEY MAY BE WAVY DUE TO SELECTIVE ATROPHY OF CORTEX OVERLYING THE MEDULLARY SEGMENTS OF THE KIDNEY ETIOLOGY: ANALGESICS, DIABETES, INFECTION with OSTRUCTION TUBERCULOSIS, SS DISEASE
Slide 108-

PAPILLARY NECROSIS
Slide 109-

UROEPITHELIAL TUMORS RETROGRADE PYELOGRAM
Slide 110-

EDEMA OF RENAL PELVIS, URETER
Slide 111-

ANTICOAGULATED PATIENT WITH HEMATURIA
Slide 112-

URETHRAL PSEUDODIVERTICULI RISK OF MALIGNANCY
Slide 113-

URETERAL PSEUDODIVERTICULI SMALL (2-5 MM) OUTPOUCHINGS HYPERPLASIA OF TRANSITIONAL EPITHELIUM RELATED TO CHRONIC INFECTION ASSOCIATED WITH TRANSITIONAL CELL CA HAVE PRECEDED MALIGNANCY BY 2-10 YEARS PATIENTS MUST BE CLOSELY MONITORED
Slide 114-

RECURRENT URETERAL MALIGNANCY POST OP IN URETERAL STUMP
Slide 115-

UROEPITHELIAL TUMORS EXCRETORY UROGRAM
Slide 116-

EXCRETORY UROGRAM RENAL PELVIS FILLING DEFECT SINGLE OR MULTILPLE FILLING DEFECTS SESSILE OR FLAT SMOOTH, IRREGULAR, STIPPLED SURFACE COLLECTING SYSTEM DILATED CALYX DILATED COLLECTING SYSTEM AMPUTATED CALYX OR INFUNDIBULUM ATROPHIC KIDNEY NONFUNCTIONING KIDNEY NEPHROGRAM DEFECT DUE TO TUMOR INVASION OR COLLECTING SYSTEM OBSTRUCTION MASS LIKE DEFECT
Slide 117-

EXCRETORY UROGRAM URETER CALIBER OF URETER NORMAL CALIBER DILATED PROXIMAL TO LESION WITH DILATED COLLECTING SYSTEM WITHOUT DILATED COLLECTING SYSTEM NARROWED AT SITE OF LESION URETER AT SITE OF LESION GOBLET SIGN (BERGMAN SIGN) STRICTURE SMOOTH AND CIRCUMFERENTIAL ECCENTRIC IRREGULAR MULTIPLE LESIONS
Slide 118-

UROEPITHELIAL TUMORS COMPUTED TOMOGRAPHY
Slide 119-

COMPUTED TOMOGRAPHY SCANNING SEQUENCES UNENHANCED CORTICOMEDULLARY PHASE NEPHROGRAPHIC PHASE DELAYED OPACIFY COLLECTING SYSTEM, URETER AND BLADDER APPROPRIATE COLLIMATION
Slide 120-

COMPUTED TOMOGRAPHY FINDINGS SIMILAR TO EXCRETORY UROGRAPHY NEED DELAYED SCANNING TO OPACIFY COLLECTING SYSTEM NEED THIN COLLIMATION TO SHOW SMALL LESIONS CT AFTER IVP IS VALUABLE TO DIFFERENTIATE TUMOR FROM CROSSING VESSEL, STONE, PERIPELVIC FAT OR MASS STAGING
Slide 121-

UROEPITHELIAL TUMORS ANGIOGRAPHY
Slide 122-

ANGIOGRAPHY UROEPITHELIAL NEOPLASMS ARE HYPOVASCULAR LARGE TUMOR VESSELS ARE RARE TUMOR VESSELS MAY BE SUBTLE OR ABSENT ABNORMAL VESSELS, WHEN PRESENT CAN BE IDENTICAL TO NONMALIGNANT DISEASE BE IDENTICAL TO POORLY VASCULARIZED RENAL CELL CA
Slide 123-

BENIGN UROEPITHELIAL NEOPLASMS MESODERMAL NEOPLASMS SMOOTH MUSCLE NEURAL VASCULAR PAPILLOMA GRADE 1 CONSIDERED TO BE MALIGNANCY INVERTED PAPILLOMA RARE, ALMOST EXCLUSIVELY IN MEN FIBROEPITHELIAL POLYPS
Slide 124-

FIBROEPITHELIAL POLYP FIBROUS TISSUE, SMOOTH MUSCLE, VESSELS, NERVE CELLS COVERED BY UROEPITHELIUM MOST ARISE IN URETER ELONGATED AND THIN, FINGER LIKE DISTAL BRANCHES HIGHLY MOBILE