Percutaneous access for the diagnosis of urothelial neoplasms: pictorial essay with anatomopathological correlation

Urothelial carcinoma is a rare malignant neoplasm, accounting for only 5% to 7% of kidney tumors and 5% of urothelial tumors. During the management of urothelial carcinoma, anatomopathological evaluation is used for stratifying the tumors into different prognostic groups to aid in the evaluation of treatment results and to optimize the management of patients. Percutaneous image-guided biopsy is a safe and feasible procedure, with high sensitivity and accuracy rates. Although image-guided percutaneous biopsy of the urinary tract is a relatively uncommon procedure, it can be considered an option in selected cases or when traditional methods, such as the ureteroscopic technique, are not possible.

Keywords:
Percutaneous access; Urinary tract; Malignancy

Authorship

Thiago Franchi Nunes Correspondence: Dr. Thiago Franchi Nunes. Avenida Senador Filinto Müller, 355, Vila Ipiranga. Campo Grande, MS, Brazil, 79080-190. Email: thiagofranchinunes@gmail.com.

Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil.Universidade Federal de Mato Grosso do SulBrazilCampo Grande, MS, BrazilHospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil.

https://orcid.org/0000-0003-0006-3725

Tiago Kojun Tibana

https://orcid.org/0000-0001-5930-1383

Rômulo Florêncio Tristão Santos

https://orcid.org/0000-0002-8679-7369

Bernardo Bacelar de Faria

Laboratório Scapulatempo, Campo Grande, MS, Brazil.Laboratório ScapulatempoBrazilCampo Grande, MS, BrazilLaboratório Scapulatempo, Campo Grande, MS, Brazil.

https://orcid.org/0000-0002-4258-2198

Vinicius Adami Vayego Fornazari

Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

https://orcid.org/0000-0002-5880-1703

Edson Marchiori

Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0001-8797-7380

Correspondence: Dr. Thiago Franchi Nunes. Avenida Senador Filinto Müller, 355, Vila Ipiranga. Campo Grande, MS, Brazil, 79080-190. Email: thiagofranchinunes@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Laboratório Scapulatempo, Campo Grande, MS, Brazil.Laboratório ScapulatempoBrazilCampo Grande, MS, BrazilLaboratório Scapulatempo, Campo Grande, MS, Brazil.

Figures

Figures (5)

Thumbnail

Figure 1
A: Ultrasound of the bladder showing a 17-G × 13-cm coaxial needle (arrow) positioned adjacent to the vegetating lesion on the left-side wall of the bladder. B: Percutaneous biopsy using an 18-G × 16-cm tru-cut needle. C: Anatomopathological examination revealed invasive urothelial carcinoma.

Thumbnail

Figure 2
A: CT scan of the abdomen, axial section, showing an ill-defined urothelial lesion in the middle third of the right kidney. B: Performance of the CT-guided biopsy (arrow) using the coaxial technique after injection of the contrast agent in the excretory phase. C: Anatomopathological examination revealed invasive urothelial carcinoma.

Thumbnail

Figure 3
A: Urethrography showing an obstructive lesion in the right distal ureter and crossing of the obstructive site using a hydrophilic guidewire up to the bladder. B: A 7-F × 45-cm sheath positioned up to the region close to the obstructive site, and performance of forceps biopsy. C: Pathological examination revealed well-differentiated urothelial neoplasia.

Thumbnail

Figure 4
A: Pyelography performed before percutaneous insertion of the double J catheter showing stenosis of the proximal ureter with parietal irregularities (arrow). B: Post-contrast coronal abdominal CT scan, MIP reconstruction, showing the properly positioned double J catheter. C: CT-guided percutaneous biopsy with posterior access and coaxial technique showing ureter thickening with maintenance of the double J catheter for ureteral protection. Anatomical and pathological examination revealed an inflammatory pseudotumor of the ureter.

Thumbnail

Figure 5
A: T1-weighted magnetic resonance imaging of the pelvis showing marked hydronephrosis of the right kidney, along with an extraperitoneal pelvic lesion in the distal ureter and signs of invasion of the bladder, seminal vesicle, and prostate. B: With the patient in the supine position, pyelography was performed before the procedure that confirmed complete ureteral duplication. C: Percutaneous insertion of a double J catheter (upper cup) and nephrostomy (lower cup). D,E: Endorectal ultrasound and fluoroscopy-guided percutaneous biopsy. F: Anatomopathological report revealed poorly differentiated urothelial neoplasia.

Figure 1 A: Ultrasound of the bladder showing a 17-G × 13-cm coaxial needle (arrow) positioned adjacent to the vegetating lesion on the left-side wall of the bladder. B: Percutaneous biopsy using an 18-G × 16-cm tru-cut needle. C: Anatomopathological examination revealed invasive urothelial carcinoma.

Figure 2 A: CT scan of the abdomen, axial section, showing an ill-defined urothelial lesion in the middle third of the right kidney. B: Performance of the CT-guided biopsy (arrow) using the coaxial technique after injection of the contrast agent in the excretory phase. C: Anatomopathological examination revealed invasive urothelial carcinoma.

Figure 3 A: Urethrography showing an obstructive lesion in the right distal ureter and crossing of the obstructive site using a hydrophilic guidewire up to the bladder. B: A 7-F × 45-cm sheath positioned up to the region close to the obstructive site, and performance of forceps biopsy. C: Pathological examination revealed well-differentiated urothelial neoplasia.

Figure 4 A: Pyelography performed before percutaneous insertion of the double J catheter showing stenosis of the proximal ureter with parietal irregularities (arrow). B: Post-contrast coronal abdominal CT scan, MIP reconstruction, showing the properly positioned double J catheter. C: CT-guided percutaneous biopsy with posterior access and coaxial technique showing ureter thickening with maintenance of the double J catheter for ureteral protection. Anatomical and pathological examination revealed an inflammatory pseudotumor of the ureter.

Figure 5 A: T1-weighted magnetic resonance imaging of the pelvis showing marked hydronephrosis of the right kidney, along with an extraperitoneal pelvic lesion in the distal ureter and signs of invasion of the bladder, seminal vesicle, and prostate. B: With the patient in the supine position, pyelography was performed before the procedure that confirmed complete ureteral duplication. C: Percutaneous insertion of a double J catheter (upper cup) and nephrostomy (lower cup). D,E: Endorectal ultrasound and fluoroscopy-guided percutaneous biopsy. F: Anatomopathological report revealed poorly differentiated urothelial neoplasia.

How to cite

copy

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês
Português

Versões e tradução automática

Versão original do texto

English
Português

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Percutaneous access for the diagnosis of urothelial neoplasms: pictorial essay with anatomopathological correlation

PlumX

Mensagem

[1] Correspondence: Dr. Thiago Franchi Nunes. Avenida Senador Filinto Müller, 355, Vila Ipiranga. Campo Grande, MS, Brazil, 79080-190. Email: thiagofranchinunes@gmail.com.