KEY FACTS
Terminology
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Malignant tumor of transitional epithelium extending from calyces to ureteral orifices
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a.k.a. transitional cell carcinoma
Imaging
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Hypoechoic infiltrative tumor in renal pelvis or ureter
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Wall thickening or intraluminal soft tissue mass
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Papillary or sessile mass
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Secondary hydronephrosis and calyceal dilatation
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Advanced tumor: Diffusely infiltrating renal mass, invading sinus fat but with preservation of renal contour
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Hypovascular on color Doppler
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CT or MR with contrast superior to US for diagnosis and staging
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MRU: Alternative to CTU in patients with iodinated contrast allergy
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Contrast-enhanced US may be option in patients unable to have enhanced CT or MR but limited for staging
Top Differential Diagnoses
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Renal cell carcinoma
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Lymphoma
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Blood clot or hemonephrosis
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Other causes of obstruction or urothelial thickening
Pathology
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10% of all renal tumors: Renal pelvis: 8%; ureter: 2%
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Multifocality with synchronous and metachronous tumors; most common in bladder
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Highest recurrence rate of any cancer
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Risk factors include: Tobacco use, chemical carcinogens, recurrent urinary infections and stones
Clinical Issues
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Gross or microscopic hematuria (70-80%), flank pain (20-40%), lumbar mass (10-20%)
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Peak incidence: 70-80 years (M:F = 3:1)
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Most common sites of recurrence for upper tract urothelial carcinoma include bladder (22-47%) and contralateral collecting system (2-6%)
Scanning Tips
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Look for upper tract lesions in setting of bladder cancer
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Use color Doppler to differentiate tumor from clot/debris
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Follow dilated collecting system to point of transition and look for pathology there
and the proximal ureter 
. Hydronephrosis ± dilated calyces are commonly associated with upper tract urothelial carcinoma.
and cortical loss 
secondary to a poorly defined hyperechoic mass in the renal pelvis 
. The patient had liver metastases from this upper tract urothelial cancer.
. Smaller tumors may be occult on ultrasound.
extending into the calyces. The contralateral renal pelvis 
was normal.
with complete loss of normal architecture. A lobulated/papillary hyperechoic mass 
extends from the renal pelvis into calyces.
extends into the calyces. There is severe hydronephrosis and cortical thinning 
as well as hepatomegaly and liver metastases 
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