In hydronephrosis of the kidneys and ureters, there is inflammation of both kidneys and ureters. Inflammation of the kidneys may appear similar. However, the ureters maybe asymmetrically affected.
Two separate soft tissue masses can surround the ureters at two different locations along each ureter. The right soft tissue mass can surround the distal part of the ureter (about 4 cm). The left soft tissue mass can surround the proximal part of the ureter (about 4 cm).
The soft tissue mass may continue to grow and compress on the ureters and stop urine flow into the urinary bladder, leading to little or no urine. The patient may not suffer any pain (asymptomatic) in the beginning . However, later on, the patient may suffer great pain as renal conditions worsen.
There are 2 investigations to be done: CT Urography, and biopsy.
CT Urography is for evaluation of the ureters. The radiologist and urologist will investigate to find out the underlying cause(s):
- Congenital abnormalities
- Filling defects
- Dilatation
- Narrowing
- Deviations in the course of urine flow and output
Biopsy is to investigate what the soft tissue mass is. Biopsy may show malignant (cancerous) growth. It maybe limited or have spread. The cytologist in Pathology will inform. Fine Needle Aspiration Biopsy (FNAB) involves aspirating a small volume of biopsy sample via a small keyhole made in the abdomen. Any biopsy is painful and will need anaesthesia.
Treatment is by surgical removal of the soft tissue masses surrounding the ureters.
The entire uterus may have to be removed too.
Radiotherapy, chemotherapy etc may be needed.
External links:
CT Urography for evaluation of the ureter
https://pubs.rsna.org/doi/full/10.1148/rg.2015140209
Retroperitoneal sarcoma of the ureters
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049017/pdf/cro-0007-0301.pdf
Soft tissue sarcomas of the kidneys
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387353/pdf/rt-2015-1-5635.pdf
Fibrosarcoma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732833/pdf/oncotarget-08-104638.pdf
Malignant soft tissue tumors
https://www.cedars-sinai.edu/Patients/Health-Conditions/Soft-Tissue-Tumors---Malignant.aspx
Urothelial Tumors of the Renal Pelvis and Ureters: Problem, Epidemiology, Etiology
https://emedicine.medscape.com/article/452449-overview#a5
https://emedicine.medscape.com/article/452449-overview#a7
Ureteral neoplasms
https://pubs.rsna.org/doi/pdf/10.1148/radiographics.10.2.2183298
Leiomyosarcoma of the distal ureter
https://www.um.edu.mt/umms/mmj/PDF/547.pdf
Kidney tumor > Renal pelvic tumors > Urothelial carcinoma of renal pelvis
http://www.pathologyoutlines.com/topic/kidneytumormalignanturothelialcarcinoma.html
Transitional cell carcinoma (TCC)
https://radiopaedia.org/articles/transitional-cell-carcinoma-ureter?lang=us
1 comments:
Nice article :D
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