RESUMO
【Objective】 To reduce the misdiagnosis rate by analyzing the clinical data of patients with primary upper tract urothelial carcinoma (UTUC) complicated with calculi. 【Methods】 Clinical data of 7 UTUC with calculi patients treated during Sep.2018 and Apr.2022 were retrospectively analyzed, including general data, time from visit to diagnosis, imaging data, urine exudation cytological results, surgical methods, pathological stages and follow-up data. 【Results】 The ratio of male to female was 3∶4, and the mean age was 66.4 (55-72) years. The initiate imaging examination results only showed calculi, but did not indicate suspicious tumor (including 1 case with missing data). The median time from the first visit to diagnosis was 12 months (5-36 months). Of all 7 cases, 2 (2/4) were clinically diagnosed by enhanced CT, 3 (3/4) by MRI, and 2 (2/7) by positive urine exudation cytology. All patients received surgical treatment. Postoperative pathology showed 85.71% (6/7) were high-grade UTUC. Postoperative staging was T1N0M0 in 4 cases, T3N0M0 in 2 cases, and T4N2M0 in 1 case. Adjuvant chemotherapy was conducted in 2 cases. During the median follow-up of 12 months (6-41), 1 case developed multiple systemic metastases in month 9, while the other cases had no recurrence or metastasis. 【Conclusion】 For UTUC patients without obvious filling defect on imaging, especially when ipsilateral calculi were complicated, misdiagnosis should be alerted for timely treatment and better prognosis.
RESUMO
Objective To study the diagnostic value of imageology for pyelic carcinoma.Methods The accuracy of qualitative diagnosis and sensitivity were analyzed by comparing various imaging examinations in 19 patients with pathologically proved pyelic carcinomas.Results Irregular filling defect and hydronephrosis were seen in the renal pelvis and calyces on intravenous pyelography(IVP).On CT scan,when the tumor was small,soft tissue mass was in the renal pelvis and the calyces.When the renal parenchyma involved by tumors,the soft tissue masses with unhomogeneous density,liquefaction necrosis in the renal pelvis and the parenchyma were seen.On contrast-enhanced CT scan,enhancement from slight to moderate was found in the lesion.The lesions were detected by IVP in 9/12 cases,by BUS in 10/16 cases,by CT in 18/19 cases and by MRI in 3/3 cases.Conclusion IVP and CT are the first method of choice to diagnose the pyelic carcinoma,BUS can be used as a screening method.While in evaluating the tumor involving the parenchyma of the ren or distant metastasis,CT and MRI are superior to IVP.