Upper urinary tract tumors include the same pathologic types as those of the bladder. Tumors may be papillary or nodular, muscle invasive or noninvasive. Staging systems are less well defined than for other malignancies but are analogous to the bladder TNM system.

• Stage T0: mucosal lesion without invasion
• Stage T1: involvement of the lamina propria
• Stage T2: muscularis propria invasion
• Stage T3:extension beyond the renal pelvis or ureter
• Stage T4: adjacent organ involvement, usually associated with positive lymph nodes
• Histologic subtypes
  • Transitional cell carcinoma. Approximately 85 percent of renal pelvic tumors and almost all ureteral tumors are transitional cell lesions. The male-to-female ratio is 3:1.
  • Squamous cell carcinoma (10 to 17 percent of tumors). Primarily associated with chronic irritation and renal calculi. These lesions are usually of more advanced stage and associated with leukoplakia and metaplastic changes.
  • Adenocarcinoma. This is a very rare (less than I percent) upper tract tumor. It occurs predominantly in females and is usually associated with chronic infection or irritation and is often seen in conjunction with pyelitis cystica or pyelitis glandularis.
  • The differential diagnosis of upper urinary tract filling defects includes papilloma, malakoplakia, sloughed papilla, secondary metastasis, uric acid or matrix calculi, extrinsic compression (vessels, adenopathy, retroperitoneal fibrosis), urinary tuberculosis, ureteritis or pyelitis cystica, inverted papilloma, and sarcoma.

References

• Carroll PC, Dixon CM. Surgical anatomy of the male and female urethra. Urol Clin North Am 19:339-346, 1992.
• Cataluna WJ: Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous vein: Technique and preliminary results. J Urol 140:836, 1988.
• deKernion JB, Abi-Aad AS: Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am 19:319-324, 1992.
• Forman JD, Lichter AS: The role of radiation therapy in the management of carcinoma of the male and female urethra. Urol Clin North Am 19:383-390, 1992.
• Gerbaulet A, Lambin P: Radiation therapy of cancer of the penis: Indications, advantages, and pitfalls. Urol Clin North Am 19:325-332, 1992.
• Johnson DE, Ames FC: Groin Dissection. Chicago, Yearbook Medical Publishers, 1985.
• Lowe FC: Squamous cell carcinoma of the scrotum. J Urol 130:423, 1983. Russo P, Gaudin P: Carcinoma of the penis: Diagnosis and staging. Cont Urol 4:12-31, 2000.
• Schellhammer PF, Jordan GH, Schlossberg SM: Tumors of the penis. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell's Urology, 6th ed. Philadelphia, Saunders, 1992, pp 1264-1298.
• Skinner EC, Skinner DG: Management of carcinoma of the female urethra. In: Skinner DG, Lieskovsky G, eds. Diagnosis and Management of Genitourinary Cancer. Philadelphia, Saunders, 1988, pp 490-497.

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