Transitional cell carcinoma (urinary tract)

Transitional cell carcinoma (TCC), also called urothelial cell carcinoma (UCC), is the most common primary malignancy of the urinary tract and may be found along its entire length, from the renal pelvis to the bladder

As imaging findings and treatment vary according to where along the urinary tract the tumour arises, each location is discussed separately. 

The remainder of this article concerns itself with a general discussion of transitional cell carcinomas.

Some prefer the more general term "urothelial cell" carcinoma (UCC) to describe malignant bladder carcinomas of epithelial origin since 25-37% of "transitional cell" carcinomas contains a mixture of histologic tissue types 6.

Transitional cell carcinoma is typically a tumour of older patients, with the average age of presentation being 65, and the majority of patients being over the age of 60 1. There is a strong male predilection (M:F = 4:1), at least in part due to many tumours (especially historically) having been due to industrial exposure (see below).

A number of chemical compounds have been implicated in the development of uroepithelial tumours, including 1-4

  • smoking
  • azo dye/pigment manufacturing
    • beta-naphthylamine
    • 4-aminobiphenyl
    • 4-nitrobiphenyl
    • 4,4-diaminobiphenyl
  • cyclophosphamide (also causes haemorrhagic cystitis, and bladder fibrosis)
  • Thorotrast
  • phenacetin
  • aristolochic acid (Balkan nephropathy): typically result in upper urinary tract tumours 2-3
  • heavy caffeine consumption and artificial sweeteners were suggested as risk factors but most likely are not 4

Additionally, and acting synergistically with the above-mentioned factors is stasis, which presumably acts to prolong exposure of the urothelium to any carcinogens present in the urine. This also contributes to the higher frequency of transitional cell carcinomas in the bladder compared to the upper tracts.

Clinical presentation is variable and usually non-specific. Haematuria is the most common presenting symptom for upper tract tumours. Tumours may also result in obstruction and symptomatic hydronephrosis. Occasionally patients only present once systemic symptoms of metastatic disease are present.

Distribution

The relative frequency of transitional cell carcinomas along the renal tract varies greatly, largely as a function of the surface area of each section 1:

  • renal pelvis: uncommon ~2-3%
  • ureter: least common ~1%
  • bladder: by far the most common ~97%

Transitional cell carcinomas of the have one of two main morphologic patterns:

  1. papillary
    • broad base with many frondlike papillary projections 3
    • tend to be low grade and invasion beyond the mucosa is a late feature
  2. non-papillary
    • sessile or nodular tumours
    • tend to be high grade with early invasion beyond the mucosa

Tumours are divided into three histological grades (see grading of TCCs). However, note should be made that stage is far more prognostically important than tumour grade 1,3.

The radiographic features depend on the location of the tumour, and as such are discussed individually:

Treatment options vary with the location of the tumour, but in general require surgical excision. Installation of bacille Calmette-Guerin (BCG) or mitomycin C may be used in selected cases as an alternative to surgery in some cases 5.

A critical part of the management of patients with TCCs is an awareness of the high rate of recurrence due to field effect on the urothelium. Approximately 40% of patients with an upper urinary tract TCC will go on to develop one or more TCCs of the bladder, and approximately 2-4% of patients with a bladder TCC will go on to develop one or more TCCs of the renal pelvis or ureter 2.

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Article information

rID: 9813
System: Urogenital
Synonyms or Alternate Spellings:
  • Transitional cell carcinoma
  • TCC
  • Transitional cell carcinoma (TCC)
  • TCC of the urinary tract
  • Urinary tract TCC
  • Urinary tract transitional cell carcinoma
  • Urothelial cell carcinoma (UCC)
  • UCC

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Cases and figures

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    Figure 1 : gross pathology
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    Ax T2
    Case 1: multiple bladder tumours
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    There is a relati...
    Figure 2: gross pathology
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    Bladder carcinoma...
    Case 2: bladder carcinoma in diverticulum
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    Figure 3: low grade TCC - histology
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    Renal pelvis TCC
    Case 3: renal pelvic TCC
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     Case 4: renal pelvic TCC
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