Clinical value of inflammatory biomarkers in predicting prognosis of patients with ureteral urothelial carcinoma / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical value of inflammation-related markers in predicting the prognosis of patients with ureteral urothelial carcinoma.@*METHODS@#200 patients with ureteral urothelial carcinoma were randomly divided into two groups by split sample validation: modeling group and validation group. Paraffin embedded pathological specimens of the patients were reviewed. Immunohistochemical method was used to detect tumor-infiltrating neutrophil (TIN) (CD66b+), tumor-associated macrophage (TAM) (CD163+), lymphocyte (CD+, CD4+, CD8+) counts, peripheral blood neutrophil / lymphocyte ratio (NLR) and tumor tissue neutrophil/monocyte ratio (NMR). According to the results of pathological staging, the patients were divided into non-muscle-invasive and muscle-invasive ureteral urothelial carcinoma group. The resolution of the models was evaluated, and the prognostic nomogram models including only peripheral blood parameters and all parameters were established to compare the accuracy of the two models in predicting the prognosis of patients with urothelial carcinoma of the ureter.@*RESULTS@#The median follow-up time was 36 months, the progression-free survival was 40 months, and 42 cases (21.0%) showed tumor progression within 3 years. Tumor size, pathological stage and pathological grade were all single-factor variables predicting the first recurrence of ureteral urothelial carcinoma three years after operation. Tumor size, pathological stage, pathological grade, TIN, TAM, NLR and NMR were multi-factor variables predicting the first recurrence three years after operation. Among 104 cases of non-muscle-invasive ureteral urothelial carcinoma, 10 cases (9.6%) recurred for the first time 3 years after operation, 96 cases (33.3%) of muscle invasive ureteral urothelial carcinoma, and the diffe-rence between the two groups was statistically significant (χ2=15.53, P < 0.05). The predictive nomogram model of progression free survival was established. The concordance index of progression free survi-val was 0.722 (95%CI: 0.70-0.78) in non-muscle-invasion group, and 0.725 (95%CI: 0.71-0.79) in muscle-invasion group, which was in good agreement with the observed 3-year survival rate. The results of discrimination test showed that the concordance index of the whole parameter prediction model of ureteral urothelial carcinoma was 0.726, which was higher than that of peripheral blood parameters (consistency index 0.672). The immune microenvironment of ureteral urothelial carcinoma improved the prediction accuracy of the model.@*CONCLUSION@#The prognosis prediction model based on immune inflammation-related markers was established as a perfection and supplement for the existing pathological grading and staging system, providing a basis for accurate individualized treatment of patients with urete-ral urothelial carcinoma. The prognosis prediction model based on the relevant indicators of peripheral blood samples is established, which is easy to obtain specimens, and the detection method is simple and economical, which is more conducive to clinical application.

Ureteric nephrogenic adenoma: A report of two cases.

Nephrogenic adenoma is a rare, benign, metaplastic lesion predominantly seen in urinary bladder, which occurs even more rarely in the ureters. We report two such cases, arising in the ureter. Both patients were young adult males. Histology of both cases was similar, showing tubules lined by columnar cells with hobnailing of nuclei. Immunohistochemically, both cases resembled their counterparts in urinary bladder. These lesions are important to recognize, since they can easily be confused with several malignancies.

Diffusion weighted imaging in the detection of upper urinary tract urothelial tumors

Purpose: Diffusion-weighted (DW) magnetic resonance imaging (MRI) provides information about the biophysical properties of tissues such as cell organization and density. DW imaging (DWI) is becoming important in the assessment of malignant tumors. The purpose of our study was to evaluate the capability and reliability of DWI in the evaluation of upper urinary tract urothelial tumors. Materials and methods: DWI was performed in seventeen patients with upper urinary tract urothelial tumor, previously diagnosed by either CT or retrograde pyelography. An histological evaluation was performed after surgical resection. Each MRI was carried out using a 1.5T superconductive magnet MRI system. DWI images were obtained with b value of 1000 s/mm2 under normal breathing. The apparent diffusion coefficient (ADC) values were measured. Results: In nine patients with renal pelvis tumors and seven patients with ureteral tumors, the lesions were shown as high-signal intensity in the corresponding region on DWI. In one patient with carcinoma in situ (CIS) of the ureter, the lesion was not depicted with DWI. The mean ADC value of the tumor was 1.125 ± 0.217 x 10-3 mm2/s and was significantly lower than those of the renal parenchyma (1.984 ± 0.238 x 10-3 mm2/s, p < 0.01) and the urine (2.941 ± 0.315 x 10-3 mm2/s, p < 0.01). Conclusions: In our study, the renal pelvic and ureteral tumors except CIS were shown clearly with DWI. Although further studies are required, DWI may take the place of invasive retrograde urography for detecting tumors of the upper urinary tract.

Ureteral stump transitional cell carcinoma after radical nephrectomy: a case report with review of literature

Primary transitional cell carcinoma [TCC]] of the ureter accounts for less than 1% of all malignancies of upper genitourinary tract. Ureteral stump after radical nephrectomy may develop malignancy very rarely TCC being the commonest. Definite risk exists if the urinary bladder harbored TCC. Presence of TCC of the urinary bladder and persistent urinary tract infections in a nephrectomized patient may indicate closer evaluation

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.

Tumor de ureter diagnosticado por biópsia transrectal ecoguiada / Ureteric tumor diagnosed by transrectal ultrasound guided biopsy

The transrectal route is currently the preferred one for the performance of prostatic and seminal vesicles biopsies, and its safety and good tolerance are well proved. Transrectal ultrasound, further to be commonly used to guide these biopsies, enables this route to be used for the biopsy of other pelvic organs or masses. However, this has been used only rarely for other organs than prostate or seminal vesicles. We reported a case where a transrectal biopsy was used to diagnose a suspected ureteral metastasis from a rectal adenocarcinoma. The anatomo-pathological study showed that the mass was an urothelial carcinoma of the ureter

Transitional cell carcinoma of the ureter and struvite calculi

Context: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. Case Report: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years andhad received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Metrotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.

Tumor de ureter: descriçäo de um caso; papel da ureteroscopia no diagnóstico e tratamento / Ureteral tumor: a case report; function of ureteroscopy in diagnostic and treatment

Paciente de 60 anos foi submetido à ureteroscopia por suspeita de tumor do ureter, confirmado pela biópsia que revelou carcinoma papilífero de células transicionais. O tratamento consistiu na eletrocauterizaçäo endoscópica do tumor. Onze dias após, foi ressecada a porçäo acometida do ureter e o exame anatomopatológico revelou ausência de neoplasia

Ureterorenoscopía y cirugía endoscópica de ureter: primeras experiencias / Ureterorrenoscopy and ureter endoscopic surgery: fisrt experiencies

Se presenta nuestra experiencia de ureterorenoscopía con cirugía endoscópica intracavitaria con el instrumento rígido de Pérez-Castro. Se ha aplicado a 74 pacientes con éxito en 65 casos (88%), en 37 casos se efectuó cirugía endoscópica además, efectuando extracciones de cálculos con Sonda Dormia, toma de biopsis en 2 tumores, uno ureteral y otro de cáliz superior, y un caso de extracción de cuerpo extraño. (Cateter ureteral). En 3 casos se utilizó ultrasonido para destruír bajo visión directa cálculos ureterales grandes

Pólipo fibrovascular de ureter com procedência uretral intermitente / Fibrovascular ureter polyp with urethral intermittent origin

Relata-se um caso de pólipo fibrovascular do ureter esquerdo em paciente portadora de duplicidade renoureteral completa à esquerda, cujas manifestaçöes clínicas se caracterizam por apresentar surtos de infecçäo e pela presença de tumor, o qual, emergindo de um dos meatos ureterais esquerdos, provoca sangramento e obstruçäo uretral intermitente. A propósito dessa rara patologia, discutem-se tópicos do diagnóstico e tratamento dos tumores ureterais, assinalando as peculiaridades que envolvem este caso inédito, bem como a conduta cirúrgica adotada. Esta consistiu na abordagem direta do ureter comprometido e a ressecçäo por fulguraçäo da base do pólipo. O seguimento é de 24 meses, sem recidiva tumoral