Transitional cell carcinoma CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

CT Scan

Abdominal and pelvic CT scans are helpful in the diagnosis of transitional cell carcinoma.

Transitional cell carcinoma of bladder

• Transitional cell carcinoma of bladder appear as either focal regions of thickening of the bladder wall, or as masses protruding into the bladder lumen, or in advanced cases, extending into adjacent tissues.
• Care should be taken in assessing bladder wall thickness as this changes with the degree of bladder distension and varies from patient to patient, e.g. patients with bladder outlet obstruction due to benign prostatic hypertrophy. In general, however, asymmetric mural thickening should be viewed with suspicion.
• The masses are of soft tissue attenuation and may be encrusted with small calcifications.
• Although unable to distinguish between T1, T2 and T3a (microscopic extravesical spread), CT is able to distinguish T3b tumors (stranding/nodules in perivesical fat) and T4 tumors (direct extension into adjacent structures/loss of normal fat plane).
• Care should be exercised when interpreting stranding or nodularity following transurethral resection or even biopsy, as these changes may be postoperative.
• Nodal metastases are common, observed in 30% of T2 tumors and 60% of T3 and T4 tumors.

Transitional cell carcinoma of renal pelvis

• Transitional cell carcinomas are typically of soft tissue density (8-30HU) with only mild enhancement (18-55HU), usually significantly less enhancing than renal parenchyma or renal cell carcinomas (although the the distinction cannot always be made).
• They are usually centred on the renal pelvis (rather than the renal parenchyma as is the case with RCC)
• Range in size from small filling defects (difficult to see without distension or collecting system contrast) to large masses which obliterate the renal sinus fat (TCC is one of the causes of the so-called faceless kidney).
• Unlike renal cell carcinomas that tend to distort the renal outline, even large infiltrating TCCs maintain a normal renal shape.
• Larger tumors may have areas of necrosis.
• In cases of the tumor being small and located at the pelviureteric junction with resultant hydronephrosis, a small soft tissue mass should be sought.
• In contrast to congenital PUJ obstruction, the calices are typically dilated, and the renal pelvis wall may be thickened.
• Occasionally numerous small calcification may be present, located on the surface of papillary projections.

Abdominal and pelvic CT scans are helpful in the diagnosis of transitional cell carcinoma.

Patient #1

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Patient#2

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