Ureteral transitional cell carcinoma

From Dog
A Beagle with ureteral transitional cell carcinoma showing a cast-like mass (T) filling ureteral lumen. The neoplasm has invaded ureteral wall (arrow) [1]

Ureteral transitional cell carcinoma is a rare metastatic ureteral neoplasm of the dog.

These tumors form as neoplastic changes to the ureteral transitional epithelium.

The etiology of TCC is not completely understood, and is likely multifactorial, but a number of risk factors have been associated with this condition including obesity, diet and environmental pollutants[2].

Clinically affected dogs are more often female dogs, with a predisposition reported in Scottish Terrier, Beagle, and Airedale Terrier breeds[3].

Clinically affected dogs usually present with fever, anorexia and a palpable abdominal mass. Hematuria may be evident with urinalysis[1]. Hypertrophic osteopathy, which is an infrequent finding in dogs with urinary bladder transitional cell carcinoma[4], has not been reported in this form of neoplasm.

Varying hematological changes may be observed such as leucocytosis and azotemia but are inconsistent.

These tumors are often located at the ureterovesicular junction and can grow to a significant size, resulting in secondary ureteral stenosis, secondary renal hydronephrosis and chronic renal disease.

Ascending secondary bacterial infections may contribute to a fulminating pyelonephritis.

Diagnosis is based on clinical history, radiographic and ultrasonographic imaging studies and histological examination of biopsied tissue samples.

Tumor grading is performed to ascertain metastatic index and therapeutic response.

  • grade 1 is well differentiated
  • grade 2 moderately differentiated (most common)
  • grade 3 is anaplastic

A differential diagnosis would include lymphoma, urolithiasis and urinary transitional cell carcinoma.

Treatment options available include surgical nephroureterectomy, ureteral resection and anastomosis, ureterocolonic anastomosis[5][6], radiation therapy[7] and chemotherapy (e.g. gemcitabine, cisplatin and sunitinib)[8].

Palliative care would include non-steroidal anti-inflammatory drugs (e.g. piroxicam or meloxicam)[9].

Ultrasound guided laser ablation has also been performed in urinary bladder transitional cell carcinomas but may be unsuitable in these cases[10].

In dogs, the prognosis is guarded in most cases.

References

  1. 1.0 1.1 Hanika C & Rebar AH (1980) Ureteral transitional cell carcinoma in the dog. Vet Pathol 17(5):643-646
  2. Henry CJ (2003) Management of transitional cell carcinoma. Vet Clin North Am Small Anim Pract 33:597–613
  3. Mutsaers AJ et al (2003) Canine transitional cell carcinoma. J Vet Intern Med 17:136–144
  4. Grillo TP et al (2007) Hypertrophic osteopathy associated with renal pelvis transitional cell carcinoma in a dog. Can Vet J 48(7):745-747
  5. Stone EA et al (1988) Ureterocolonic anastomosis in ten dogs with transitional cell carcinoma. Vet Surg 17(3):147-153
  6. Montgomery RD & Hankes GH (1987) Ureterocolonic anastomosis in a dog with transitional cell carcinoma of the urinary bladder. J Am Vet Med Assoc 190(11):1427-1429
  7. Withrow SJ et al (1989) Intraoperative irradiation of 16 spontaneously occurring canine neoplasms. Vet Surg 18(1):7-11
  8. Vogelzang NJ et al (2013) Antiangiogenic agents, chemotherapy, and the treatment of metastatic transitional cell carcinoma. J Clin Oncol 31(6):670-675
  9. Henry CJ (2003) Management of transitional cell carcinoma. Vet Clin Small Anim 33:597–613
  10. Cerf DJ & Lindquist EC (2012) Palliative ultrasound-guided endoscopic diode laser ablation of transitional cell carcinomas of the lower urinary tract in dogs. J Am Vet Med Assoc 240(1):51-60