RESUMO
Metastases from transitional cell carcinoma of the bladder are not widely appreciated radiographically, although they are commonly found at autopsy. Radiographic evidence of metastatic disease was reviewed in 51 patients. Sites included lung, 28; bone, 24; mediastinum, eight; liver, eight; brain, three; urethra, one; abdominal nodes, one; and extradural space, two. The patterns of lung metastases consisted of solitary nodules, multiple nodules, sigmental infiltrates, pulmonary edema, and a Pancoast tumor. A sarcoidlike pattern with hilar and interstitial disease was also seen. One patient had a malignant pleural effusion. Mediastinal lymph node enlargement was isolated or associated with lung involvement. Bone metastases demonstrated either an osteoblastic or a mixed osteolytic-osteoblastic pattern in 47% of the instances. Ivory vertebrae were identified in three patients. Because of the significance of identifying metastatic disease before any extensive curative bladder surgery, we recommend at least a preoperative chest radiograph, a bone scan, and a liver scan.
Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Carcinoma de Células de Transição/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Metástase Neoplásica , Radiografia , Neoplasias da Bexiga Urinária/patologiaRESUMO
Angiograms of 51 tests cases including 34 transitional cell carcinomas, eight inflammatory lesions, four hypernephromas, and five miscellaneous disorders were shown to six radiologists for analysis of the angiographic features and specific diagnosis. Overall accuracy was 60% with a false positive rate of 44%. The most common false positive diagnosis occurred with inflammatory lesions (seven of eight). False negative cases were variously called normal, hypernephromas, inflammatory, or other. Vessel encasement (26%), neovascularity (56%), and tumor blush (15%) were recognized far less frequently in the transitional cell tumors of this series than in previous reports in the literature. Further, when hydronephorsis was present, the angiogram was not helpful in determining the etiology. It is concluded that the "classic" angiographic findings associated with this tumor are only moderately reliable since they can be mimicked by other conditions.
