Renal pelvis and ureteral tumors
Introduction
Introduction to renal pelvic tumors and ureteral tumors Renal pelvis and ureteral tumor are most common in transitional cell carcinoma, and their etiology, pathology, clinical manifestations and treatment principles are similar to bladder tumors. The incidence of renal cell transitional cell tumors in China is higher than that reported abroad. In renal tumors, renal pelvis cancer generally accounts for less than 10%, while the third national urology academic association in China accounts for 24%. Opportunities for tumors in urothelial organs vary, with bladder tumors being the most common and fewer organs. There are more cases of upper urothelial tumors in China than in foreign countries. The carcinogens in the urothelial organ tumors are the same. The urothelial tumors have multiple organ morbidity tendencies, often in the direction of urinary flow. The first clinical hospital of Beijing Medical University accounts for 92% of the statistics. 8%. Bladder cancer occurs after 30% to 50% of upper urinary tract tumors are reported in the literature, and the chance of upper urinary tract tumors in bladder cancer is 2% to 3%. The bladder has a large volume in the urinary organs, and the urine stays for a long time. Hydrolase activates carcinogenesis. The composition of the substance, so the chance of tumor occurrence is much higher than other organs, in the specimen of bladder cancer resection, 10% of the end of the ureter has carcinoma in situ. Therefore, it can be assumed that if bladder cancer patients survive longer, it is possible to find more cases of upper urinary tract cancer. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: Bladder tumors Varicocele
Cause
Causes of renal pelvic tumors and ureteral tumors
Chemical carcinogens associated with bladder cancer are discussed in detail in the next section.
Nephropathy in the Balkans is interstitial nephritis, a common cause of ureteral ureteral cancer, including Yugoslavia, Romania, Bulgaria, Greece, etc. There are obvious regional, even villages have boundaries, slow development, renal dysfunction, similar incidence of men and women 10% of the bilateral, had conducted environmental, occupational, genetic investigations, the reasons are still unclear, because it is easy to have renal damage, superficial, multiple, treatment should preserve kidney tissue as much as possible.
Analgesic tablets can cause renal pelvic cancer. In recent years, acetaninophen (Tylen01) is considered to be carcinogenic to its metabolites. It is often necessary to accumulate more than 5 kg of cancer caused by painkillers, which is similar to the carcinogenic opportunity of smoking 15 cigarettes per day for 20 years.
Chronic stimuli such as inflammation caused by uroliths can cause renal pelvis cancer, most of which are squamous cell carcinomas. More than 50% of patients with squamous cell carcinoma have a history of calculus.
There is a familial morbidity. McCullough reported that the father and the second son had multiple upper urinary tract tumors. Gitte saw three tumors with multiple tumors and bladder tumors. The familial morbidity may be related to plum virus infection, metabolic abnormalities and exposure to carcinogen.
Prevention
Renal pelvic tumor and ureteral tumor prevention
Pay more attention to the diet, supplement nutrients, and improve your own immunity.
Complication
Renal pelvic tumor and ureteral tumor complications Complications bladder tumor varicocele
Renal ureteral ureteral cancer has the characteristics of multiple organs, and there may be bladder irritation, that is, the performance of bladder tumors. Local varicose veins may occur, and complications such as varicocele and posterior peritoneal lumbar muscle may occur.
Symptom
Symptoms of renal pelvic tumor and ureteral tumor Common symptoms Lower abdominal dull pain and soreness of the lower abdomen mass lymph node enlargement Fetal renal pelvis separation Renal pelvis dilated renal internal artery thinning or obstruction of hematuria
Male and female are 2:1, 40% to 70 years old, accounting for 80%, average 55 years old, hematuria is the most common initial symptoms, visible to the naked eye, intermittent, painless, if the blood clot passes through the ureter can cause renal colic, insect Blood strips, sometimes patients with dull pain in the waist, most patients have no obvious positive signs, but about 7% of the symptoms are dyscrasia, is a late case, 5% ~ 15% can touch the enlarged kidney, possible There are tender rib angle tenderness, there are reports that 10% to 15% have no clinical symptoms, only accidentally found in other diseases, pelvic ureteral cancer has multi-organ morbidity, there may be bladder irritation symptoms, bladder tumor performance, local spread There may be varicocele, posterior peritoneal lumbar muscle syndrome, etc., squamous cell carcinoma often manifests as a stone or infection.
Examine
Examination of renal pelvic tumors and ureteral tumors
1. Excretory urography: visible filling defects, should be identified with uric acid stones, matrix stones, sometimes defects may be caused by blood clots, renal parenchyma tumors and cysts may see renal pelvis and renal filling defects, sometimes with B-ultrasound and CT Diagnosis, small defects of renal pelvis may be caused by renal artery and its branches, tumor can cause ureteral non-development, especially in ureteral tumors, there is statistical sputum cancer is not developed when l/3 is high in invasive cancer, ureteral cancer does not cause 60% to 80% of the development is invasive, 35% of hydronephrosis, 20% of the ureter has a filling defect, and 85% of the normal urinary tract is a low-stage tumor.
Retrograde urography should be accompanied by retrograde angiography or other examinations.
2. Retrograde urography: its importance is:
1 angiography is clearer, especially when the effusion contrast is poorly developed;
2 may see the side of the ureteral orifice spurting, the lower ureteral tumor protrudes to the ureteral orifice;
3 directly collect the side of the urine for tumor cytology or brush biopsy;
4 cystoscopy to exclude intravesical tumors.
In retrograde angiography, excessive contrast agent may be injected into the renal pelvis to cover a small filling defect. The ureteral angiography must be filled with a full ureter to confirm the diagnosis. The bulbous catheter is ureteral angiography, and the ureteral catheter head is like an olive or acorn block. Insert the ureteral orifice into the screen to inject contrast agent, the tumor is pushed upwards, and the ureter expands like a "gob-shaped". If the calculi are not expanded below, the surface of the infused tumor is not smooth, and the urolithic edema may be misdiagnosed. Sometimes urinary stones can be combined with tumors, and ureteral polyps often show a smooth, long strip filling defect with branches.
In the case of a ureteral tumor, the following catheter can be bent or looped. For example, if the cannula passes through the tumor, it can be found that the upper part is clear urine, and the side of the catheter is hematuria.
It is necessary to prevent misdiagnosis caused by air bubbles during angiography.
3. Brush biopsy: When the patient is suspected of tumor and the cytology is positive, after the contrast agent is injected intravenously, the suspected part is selected for biopsy. The small brush passes through the F5 catheter, the tissue can be attached to the brush hair, and the brush is taken out of the ureteral catheter. There may be small tissue fragments in the effluent, repeated flushing with a small amount of saline, collecting the fluid for examination, and the ureteral catheter should be left overnight and pulled out.
4. Ultrasound examination: It can distinguish between stone and soft tissue lesions, tumor and necrotic nipple, blood clot, matrix stones, etc. It is difficult to identify, and ureteral lesions are not reliable.
5. CT: can distinguish between renal cell and renal cell carcinoma and renal cell carcinoma.
1 The solid mass in the renal pelvis has or the pelvis is spherical, and the renal sinus fat is displaced and compressed;
2 after the contrast agent was injected, the enhancement was not obvious;
3 curve of contrast agent filling near the tumor;
4 renal parenchyma enhanced extension (when the tumor has a large impact on drainage);
5 retain the kidney shape.
6. Renal angiography: The intrarenal artery can be found to be thin or obstructed, often indicating infiltration, and tumor bleeding can be seen above 3 cm in diameter.
7. Ureteroscopy and pyeloscopy: may be used for diagnosis and treatment, and renal pelvis may cause tumor transplantation, and its actual value is difficult to draw conclusions.
8. NMR: can be used to identify kidney cancer and renal pelvic cancer, can also be used for the diagnosis of ureteral lesions, and can be free of contrast agents (allergic to contrast agents), such as the development of the application of contrast agents can improve the accuracy of the diagnosis.
9. Cytological examination: 80% false negative for well-differentiated low-stage tumors, and 60% positive or highly suspected poorly differentiated tumors.
Diagnosis
Diagnosis and diagnosis of renal pelvic tumor and ureteral tumor
diagnosis
1. Excretory urinary angiography: visible filling defects, should be identified with uric acid stones, matrix stones, sometimes defects may be caused by blood clots, renal parenchyma tumors and cysts may see renal pelvis and renal filling defects, sometimes with B-ultrasound and CT Can be diagnosed, small defects of the renal pelvis may be caused by the renal artery and its branches, tumors can cause ureteral non-development, especially in ureteral tumors, there are statistics of renal pelvic cancer not developed when l / 3 high-phase invasive cancer, ureteral cancer 60% to 80% of invasiveness caused by non-development, 35% of hydronephrosis, 20% of hydronephrosis and 20% of urinary tract, and 85% of normal urinary tract are low-grade tumors, excretory urinary Retrograde angiography or other examinations should be used when the contrast is poor.
2. Retrograde urography: its importance is:
1 angiography is clearer, especially when the effusion contrast is poorly developed;
2 may see the side of the ureteral orifice spurting, the lower ureteral tumor protrudes to the ureteral orifice;
3 directly collect the side of the urine for tumor cytology or brush biopsy;
4 cystoscopy to exclude intravesical tumors.
In retrograde angiography, excessive contrast agent may be injected into the renal pelvis to cover a small filling defect. The ureteral angiography must be filled with a full ureter to confirm the diagnosis. The bulbous catheter is ureteral angiography, and the ureteral catheter head is like an olive or acorn block. Insert the ureteral orifice into the screen to inject contrast agent, the tumor is pushed upwards, and the ureter expands like a "gob-shaped". If the calculi are not expanded below, the surface of the infused tumor is not smooth, and the urolithic edema may be misdiagnosed. Sometimes urinary stones can be combined with tumors. The ureteral polyps often show a smooth, long strip filling defect. They can have branches. When the ureteral tumor is used, the following catheters can be bent or looped. For example, the intubation can be found through the tumor as clear urine. And the blood flowing out beside the catheter, it is necessary to prevent the misdiagnosis caused by the introduction of air bubbles during the angiography.
3. Brush biopsy: When the patient is suspected of tumor and the cytology is positive, after the contrast agent is injected intravenously, the suspicious part is selected to take the biopsy. The small brush passes through the F5 catheter, the tissue can be attached to the brush hair, and the brush is taken out. There may be small tissue fragments in the ureteral catheter effluent, repeated flushing with a small amount of saline, collecting fluid for examination, and the ureteral catheter should be left overnight and pulled out.
4. Ultrasound examination: It can distinguish between stone and soft tissue lesions, tumor and necrotic nipple, blood clot, matrix stones, etc. It is difficult to identify, and ureteral lesions are not reliable.
5. CT: can distinguish between renal cell and renal cell carcinoma and renal cell carcinoma, renal pelvic cancer is:
1 The solid mass in the renal pelvis has or the pelvis is spherical, and the renal sinus fat is displaced and compressed;
2 after the contrast agent was injected, the enhancement was not obvious;
3 curve of contrast agent filling near the tumor;
4 renal parenchyma enhanced extension (when the tumor has a large impact on drainage);
5 retain the kidney shape.
6. Renal artery angiography: The intrarenal artery can be found to be thin or obstructed, often indicating infiltration, and tumor bleeding can be seen above 3 cm in diameter.
7. Ureteroscopy and pyeloscopy: may be used for diagnosis and treatment, and renal pelvis may cause tumor transplantation, and its actual value is difficult to draw conclusions.
8. NMR: can be used to identify renal cancer and renal pelvic cancer, can also be used for the diagnosis of ureteral lesions, and can be free of contrast agents (allergic to contrast agents), such as the development of the application of contrast agents can improve the accuracy of the diagnosis.
9. Cytological examination: 80% false negative for well-differentiated low-stage tumors, and 60% positive or highly suspected poorly differentiated tumors.
Differential diagnosis
Ureteral calculi
Ureteral calculi can cause upper urinary tract obstruction. When it is a negative stone, urography can be found in the ureter with filling defects, which need to be differentiated from ureteral tumors. Ureteral calculi are more common in young adults under 40 years old, characterized by colic, gross hematuria Rare, mostly intermittent microscopic hematuria, often coexist with renal colic, retrograde ureteral tumor local expansion, cup-like changes, and stones incomparable changes, CT flat-scanning stones showed high density shadow, the tumor showed soft tissue shadow.
2. Ureteral polyps
More common in young adults under 40 years old, long history, blood coat is not obvious, ureteral angiography see filling defects, but the surface is smooth, long strips, the scope is larger than the ureteral tumor, more than 2cm, more in the proximal renal pelvis and ureteral junction At the junction of the ureter and bladder, it is negative to repeatedly find tumor cells from the urine.
3. Ureteral stenosis
It is characterized by lumbar pain and hydronephrosis. It should be differentiated from uremic cancer. There are various reasons for ureteral stricture. Non-tumor ureteral narrow hematuria history, urography is simple stenosis, no filling defect, repeated urine The tumor cells were found to be negative.
4, blood in the ureter, hematuria
The ureteral filling defect is similar to ureteral tumor, but the ureteral blood clot is variability. Two times of contrast examination at different times can be found to change its position, size and morphology.
5. Bladder cancer
Bladder cancer located around the ureteral orifice, covering the ureteral orifice, need to be differentiated from the lower ureteral cancer such as the bladder, ureteral cancer has two conditions: one is the tumor has pedicle, the pedicle is in the ureter; the second is the tumor is not pedicle, the tumor is in The ureter and the bladder are identified by cystoscopy and urinary tract.
