Ureteral Tumors
Ureteral tumors are rare and usually of urothelial origin. Urothelial tumors are most frequently malignant, and their prognosis is variable, depending on their degree of differentiation (grading) and their extension through the ureteral wall (staging). Mu
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Ureteral Tumors Ph. Plante, T. Smayra, L. Bouchard, F. Joffre, P. Seguin, G. Escourrou, Ph. Otal
CONTENTS 6.1 6.1.1 6.1.2 6.2 6.2.1 6.2.2 6.2.3 6.2.4 6.2.4.1 6.2.4.2 6.2.4.3 6.2.5 6.2.6 6.3 6.3.1 6.3.2 6.3.3 6.3.4
Benign Ureteral Tumors 127 Ureteral Fibroepithelial Polyp 127 Other Benign Tumors of the Ureter 129 Primary Malignant Tumors of the Ureter 130 Pathophysiology 130 Pathology 131 Clinical Symptoms 132 Imaging 133 Excretory Urography 133 Retrograde Ureteropyelography 135 New Imaging Techniques 137 Treatment 142 Mesenchymatous Malignant Tumors 142 Secondary Malignant Tumors of the Ureter 142 Ureteral Involvement Secondary to Urothelial Tumor 143 Renal Tumors with Ureteral Extension 144 Direct Extension from an Adjacent Retroperitoneal or Pelvic Tumor Process 144 True Ureteral and Periureteral Metastasis 146 References 150
Ureteral tumors are rare and usually of urothelial origin. Urothelial tumors are most frequently malignant, and their prognosis is variable, depending on their degree of differentiation (grading) and their extension through the ureteral wall (staging). Much rarer are tumors of connective tissue origin, which are most frequently benign (Table 6.1). The development of new radiological (ultrasonography, computed tomography, MRI) and endoscopic (ureteroscopy) techniques has improved diagnostic performance and permits a more precise pretherapeutic investigation. The indications for excretory urography (EU), long the key diagnostic tool, are now challenged in the light of the new urographic techniques using CT and MRI multiplanar reconstructions. P. Plante, MD; P. Seguin, MD Service d’Urologie T. Smayra, MD; L. Bouchard, MD; Ph. Otal, MD; F. Joffre, MD Service de Radiologie G. Escourrou, MD Service d’Anatomo-pathologie, CHU Rangueil, 1, avenue JeanPoulhès, 31403 Toulouse Cédex 4, France
F. Joffre et al. (eds.), Radiological Imaging of the Ureter © Springer-Verlag Berlin Heidelberg 2003
6.1 Benign Ureteral Tumors 6.1.1 Ureteral Fibroepithelial Polyp Fibroepithelial polyp is a rare tumor, representing less than 20% of all the primitive ureteral tumors (De Bruyne et al. 1990). Approximately 150 cases are reported in the literature (Bellin et al. 2002). However, it is by far the most frequent benign tumor of the ureter, the benign nature of papillomas not being definitely established. Ureteral fibroepithelial polyp is not a real tumor, but consists of hyperplasia of fibroconnective tissue proliferation covered by normal epithelium (Abeshouse 1956; Corkill et al. Table 6.1. Classification of ureteral tumors, according to Bennington and Beckwith (1975) and Richie (1988) Primitive tumors Epithelial tumors Benign Papilloma Inverted papilloma Malignant Transitional cell carcinoma Transitional cell carcinoma with differentiation squamous differentiation glandular differentiation mixed Squamous cell carcinoma Adenocarcinoma Undifferentiated carcinoma Mesodermal tumors (nonepithelial) Benign tumors Fibroepithelial polyp Leiomyoma Hemangioma Neurinoma Malignant tumors Leiomyosarcoma Secondary tumors Seeding f
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