Angiographie Demonstration of a Benign Tumor of the Ureter

Abstract

The diagnosis of ureteral tumor may be suggested preoperatively in about 70 per cent of all cases by means of such diagnostic technics as urinary sediment examination, cytology, intravenous urography, cystoscopy, and retrograde pyelography (1). Percutaneous aortography and selective arteriography are potential methods of increasing the diagnostic accuracy. Boijsen in 1962 first described the demonstration of 2 ureteral neoplasms by aortic angiography and selective renal angiography (2). The histological examination revealed a transitional-cell carcinoma in both patients, who were later included in a series of 17 cases of ureteral tumors reported by Jö(5). Five of these were examined by angiography. Only in Boijsen's patients was pathologic vasculature demonstrated. The purpose of this report is to present an additional instance of preoperative demonstration of a ureteral neoplasm by selective renal angiography. A 34-year-old female entered the University of Chicago Clinics with a history of gross hematuria and low-grade fever of three weeks duration. Bleeding had ceased three days prior to admission. Urinalysis revealed 4-8 RBC/HPF on unspun specimen. No abnormal cells were seen. Intravenous urography demonstrated a normal right kidney and collecting system, but the left kidney was not visualized, although its size and contour appeared normal on a preliminary film. Nonopacified material in the right side of the bladder was presumed to represent blood clots. At cystoscopy clots were seen oozing from the left ureteral orifice. At retrograde pyelography, however, the distal left ureter was normal, but obstruction to the retrograde flow of contrast material occurred at the level of the pelvic brim (Fig. 1). A selective left renal arteriogram demonstrated a convolution of small irregular vessels over the psoas muscle at the level of the third lumbar vertebra (Figs. 2 and 3). These tumor vessels were supplied from a capsular branch of the renal artery extending along the left ureter. Dense accumulation of contrast material persisted in the tumor following injection. An aortogram revealed that this tumor was supplied solely from the renal artery and not from other branches of the aorta. A diagnosis of a probably malignant tumor of the ureter was made. Laparotomy disclosed a well encapsulated tumor at the junction of the middle and the upper thirds of the ureter, loosely adherent to the psoas muscle. The renal pelvis was markedly distended and contained blood clots. A left nephroureterectomy was performed. Dissection showed a mass 9 cm long, with a diameter of 1 cm, which had arisen from the wall of the ureter and invaded the lumen and extended externally. The tumor was diagnosed as a leiomyoma. The histopathologic features of this tumor will be described in a separate report (6). Discussion With the usual diagnostic methods, a presumptive diagnosis of ureteral tumor can be made in a majority of cases.