Ureteral tumor
Introduction
Introduction to ureteral tumors Ureteral tumors are relatively rare in the clinic. In 1841, French pathologist Rayer first described ureteral tumors. In 1902, Albarran reported the first case of a primary ureteral tumor that was diagnosed before surgery. As of 1976, there were only 2,200 cases reported in the world literature, while the main literature in the country counted primary ureteral malignancies. By August 1996, more than 280 cases were reported. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: bladder tumor
Cause
Ureteral tumor cause
(1) Causes of the disease
The etiology of ureteral tumors is not fully understood, similar to renal pelvis and bladder tumors, smoking, drinking coffee, abuse of analgesics, certain special occupations, chronic inflammation, stagnant water, stones, chemotherapy with cyclophosphamide, genetics, etc. The incidence and development of ureteral tumors are related. Some studies have found that smokers have a higher risk of ureteral tumors than renal pelvic tumors and bladder tumors, and there is a dose-effect relationship between the amount of smoking and the risk of developing tumors; while drinking a large amount of coffee also increases the incidence of ureteral tumors. The possibility of long-term use of analgesics such as phenacetin will increase the incidence of ureteral tumors; those who are engaged in chemistry, petrochemistry, plastics industry, long-term exposure to coal, asphalt, cocaine, tar have ureteral tumors. The possibility is greatly increased; chronic bacterial infections, urethral stones, obstruction are prone to squamous cell carcinoma, and the possibility of adenocarcinoma is much less; cyclophosphamide as a chemotherapy drug is also considered to not only increase bladder tumors. The likelihood that ureteral tumors will occur will also increase.
(two) pathogenesis
Tumors of bilateral ureters (at the same time or at different time) accounted for 0.9% to 1.6% of the total number of ureteral tumors. About 73% of ureteral tumors were located in the lower ureter, about 24% were in the middle of the ureter, and only about 3% in the upper ureter.
Most ureteral tumors are transitional cell carcinoma, accounting for 93%. Histopathological features are similar to bladder transitional cell carcinoma. Squamous cell carcinoma and adenocarcinoma are rare. Epithelial papilloma is the most common in a small number of benign tumors. Accounted for 75%, of which inverted papilloma often coincides with malignant tumors. It is reported in the literature that about 18% of malignant tumors occur (simultaneously or at different times) ureteral papilloma, so for the diagnosis of inverted papilloma Patients need to exclude ureteral malignancies, another benign tumor is fibroepithelial polyps, TNM staging with renal pelvic tumors, ureteral transitional epithelial cancer can be spread through epithelial expansion (direct infiltration or planting) and lymph, blood.
1. According to the source of the tumor, ureteral tumors can be divided into three categories.
(1) ureteric epithelial origin: malignant transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, undifferentiated carcinoma; benign transitional cell papilloma.
(2) ureter and surrounding tissue other than ureteral epithelium Source: malignant fibrosarcoma, leiomyosarcoma, liposarcoma, angiosarcoma, carcinoid sarcoma; benign fibroids, schwannomas, leiomyoma, hemangioma, Fibrous polyps.
(3) Organs or tissue sources other than the ureter: all are malignant tumors, such as metastatic carcinoma, metastatic sarcoma.
2. The clinical staging mainly includes the International Anticancer Association and Jewett two staging methods.
Prevention
Ureteral tumor prevention
Patients with ureteral tumors, especially malignant tumors, whether using ureteroscopy and conservative surgery, or after radical surgery, should develop detailed and rigorous follow-up plans, including: 1 regular examination of urine routine and urine exfoliated cells; Reexamination of intravenous urography or retrograde pyloric ureteroscopy; 3 periodic cystoscopy and ureteroscopy, the first 2 years, once every 3 months, every 6 months thereafter; 4 the choice of mitomycin or BCG and other chemotherapy drugs Intravesical instillation is performed regularly to prevent tumor recurrence.
Complication
Ureteral tumor complications Complications bladder tumor
40% of patients may have tumors in other parts of the urinary tract, of which about 21% have bladder tumors.
Symptom
Symptoms of ureteral tumors Common symptoms ureteral pyelospasm Carcinoma ureteral stricture abdominal pain abdominal mass hematuria
The ureteral tumors accounted for 80% of the age of 40 to 70 years, with an average age of 55 years. Hematuria is the most common initial symptoms. Gross hematuria, low back pain and abdominal mass are the three common symptoms of ureteral cancer, but they are non-specific. They are easily confused with kidney, bladder tumor, ureteral calculi, hydronephrosis and other diseases. .
1. Hematuria:
Most patients often have painless gross hematuria, which occurs intermittently.
2. Pain:
The pain can be mild, and a small number of patients cause severe renal colic or discharge of strips of blood clots due to hematuria through the ureter. If it spreads to the pelvic or abdominal organs, it can cause pain in the corresponding parts. It is often a wide and constant knife-cut pain. Once such pain occurs, it is often a late symptom and rarely survives for more than 1 year.
3. Lump:
Ureteral tumors can account for 25% to 30% of lumps and lumps. It is rare for ureteral tumors to be paralyzed and lumps. The majority of patients with lumps are not the tumor itself, but often a swollen kidney.
4. Other:
About 10% to 15% of patients are diagnosed without any symptoms. Uncommon symptoms include frequent urination, dysuria, weight loss, anorexia and fatigue. If there is recurrent painless gross hematuria with right varicocele, it is highly suspected of right ureteral tumor.
Examine
Ureteral tumor examination
Urine routine examination
Red blood cells can be found.
Urine exfoliated cell examination
The diagnostic accuracy rate is 60% to 70%, and the flow cytometry (FCM) can be used to detect tumor cells more sensitively.
Film degree exam
(1) intravenous urography: the ureter has eccentricity or central filling defect, the surface is rough, uneven, irregular shape or oval; the ureteral contour disappears at the lesion; there are different degrees of water above the obstruction, renal function Decreased; there is a cup-shaped dilatation under the tumor.
(2) retrograde angiography: if the obstruction is complete, the retrograde angiography is similar to that of intravenous urography, the obstruction tip is sharp, the edge is not uniform or the cup is mouth-shaped, the edge of the cup is rough, asymmetrical, retrograde angiography shows the ureter enlargement under the cancer In the form of a "goblet", it is important for the diagnosis.
(3) CT examination: early small tumors <1 cm difficult to find, but hydronephrosis and surrounding tissue infiltration and lymph node metastasis can be observed.
(4) MRI: It is more accurate than CT in tumor staging, and it is helpful for the diagnosis of obstructive tumors with unclear diagnosis.
(5) renal angiography: the upper ureteral cancer, occasionally visible renal pelvis, thickening of the ureteral artery, extending to the tumor area, sometimes visible thin tumor blood vessels, and when the hydronephrosis occurs, the renal artery is straightened and separated.
(6) B-ultrasound: Generally, only hydronephrosis and large metastases can be found. Sometimes the tumor is moderately echoed or slightly hypoechoic, and the ureter is expanded above it.
Device inspection
(1) cystoscopy: visible ureteral vaginal bleeding in the affected side, because 20% of patients with bladder cancer, it is necessary to observe the presence or absence of tumors in the bladder, and can be retrospective angiography, can also be used to take tissue with a ureteral catheter for pathology Check, the diagnostic positive rate is up to 90%.
(2) ureteroscopy: can directly reach the tumor site, observe the tumor morphology, size and biopsy, 86% ~ 92% of patients can be diagnosed.
Diagnosis
Diagnosis and diagnosis of ureteral tumor
diagnosis
Intermittent gross hematuria with long strips of blood clots; imaging findings of ureteral filling defects; urine exfoliated cells positive or pathologically confirmed tumors can be diagnosed.
Differential diagnosis
Ureteral negative stones
More common in young adults under 40 years old, characterized by colic, gross hematuria is rare, most of them are microscopic hematuria, often coexisting with colic, ureteral negative stones can cause urinary tract obstruction above the stone, angiography found negative in the ureter, If the contrast agent can not be diagnosed, it can be used for double contrast angiography of the ureteral inflation. At this time, the negative stones can be developed, and the CT scan scans the high-density stone shadow in the ureter of the obstructive segment.
2. Ureteral polyps
More common in young adults under 40 years old, long history, angiography see filling defects, the surface is smooth, the scope is larger than the ureteral tumor, more than 2cm, even up to 10cm, more in the proximal renal pelvis and ureteral junction, repeated from the urine Find cancer cells negative, can be identified.
3. Bladder cancer
Bladder cancer located around the wall ureter can cover the ureteral orifice, which needs to be differentiated from the lower ureteral cancer into the bladder. There are two cases of ureteral cancer protruding into the bladder. One is that the tumor is pedicled, the tumor is in the bladder, and the ureter is in the ureter. There is no pedicle in the tumor, and the tumor is in the ureter and bladder. The identification is mainly by cystoscopy. The relationship between the bladder tumor and the ureteral orifice can be opened by the front end of the sheath sheath. If the pedicle is connected with the ureter, the ureteral tumor can be confirmed.
