Computerized Tomography Criteria for theDiagnosis of High Grade Papillary Urothelial Carcinoma

摘要

A 64-year-old white female complained of intermittent bouts of painless macroscopic hematuria for the last 18 months. She appeared malnourished but otherwise exhibited no abnormalities and vital signs were normal. Hemoglobin was 13.8 gm, hematocrit 38, and differential count and blood chemistry results were within normal limits. Urinalysis yielded 10 to 20 red blood cells per high power field and a specific gravity of 1,022. Urine cytology of the voided specimen showed rare mitotic figures and cellular atypia as we as some cellular pleomorphism.Excretory urogram and computerized tomography (CT) obtained elsewhere showed moderate hydronephrosis of the light kidney and upper right ureter with a classic champagne glass ureteral configuration at the S1-S2 level, suggesting low grade papillary transitional cell carcinoma. However, this finding was not consistent with cytopathological findings. Our multiphasic helical CT confirmed the presence of mild to moderate hydronephrosis of the right kidney but without significant loss of parenchyma or a detectable phase difference in enhancement, criteria that would indicate damage and significant obstruction (part A of figure).At the L5-S1 level the ureter was dilated yet the ureteral wall showed some concentric thickening (part B of figure). At the S2 level axial CT showed the ureter dilated to 1.8 cm.