Korean J Radiol.  2018 Aug;19(4):742-751. 10.3348/kjr.2018.19.4.742.

Secondary Tumors of the Urinary System: An Imaging Conundrum

• Karaosmanoglu AD
• Onur MR
• Karcaaltincaba M
• Akata D
• Ozmen MN

• KMID: 2413703
• DOI: http://doi.org/10.3348/kjr.2018.19.4.742

Abstract

Imaging features of metastases to the urinary system may closely mimic primary urinary tract tumors, and differential diagnosis by imaging alone may be problematic or even impossible in some cases. The main purpose of this article was to familiarize radiologists with imaging findings of metastasis to the urinary system on cross-sectional imaging, with an emphasis on abdominal and pelvic computed tomography and magnetic resonance imaging. In addition, we review the clinical importance and implications of metastases to the urinary tract and provide information on diagnostic work-ups.

Keyword

Urinary system; Metastasis; Kidney; Ureter; Bladder; Urethra; CT; MRI

MeSH Terms

Diagnosis, Differential
Kidney
Magnetic Resonance Imaging
Neoplasm Metastasis
Ureter
Urethra
Urinary Bladder
Urinary Tract

Figure

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  Fig. 1 75-year-old female patient with known breast cancer with recently detected pulmonary and bone metastases was referred for restaging after chemotherapy. A. Gray-scale US image demonstrates mildly hyperechoic mass (arrows) in lower pole of left kidney. Lesion is hardly discernible from background renal parenchyma on US image. B, C. Axial and coronal contrast-enhanced CT images reveal infiltrative-type hypodense solid mass (arrows) with relatively less enhancement as compared to background renal parenchyma. CT = computed tomography, US = ultrasonography

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  Fig. 2 65-year-old female with known lung cancer and brain metastasis. Post-contrast axial (A) and coronal (B) CT images show hypodense, endophytic solid lesion (arrows) in upper pole of right kidney. Biopsy confirmed metastatic nature of this mass.

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  Fig. 3 53-year-old male patient with known stage 4 lung cancer. Brain and liver metastases were previously detected. Axial (A) and coronal (B) contrast-enhanced CT images demonstrate hydronephrosis (*) in right kidney due to centrally located hypovascular mass (short arrow). Also note diffusely infiltrative mass (long arrows) in lower pole of left kidney parenchyma. Biopsy confirmed metastatic nature of centrally located right kidney mass.

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  Fig. 4 66-year-old male patient with known lung cancer and chest wall invasion. No distant metastasis was known at time of this CT scan. Axial (A) and coronal (B) contrast-enhanced CT images reveal low-attenuating, exophytic mass (arrows) that was histopathologically proven to be metastasis from lung carcinoma.

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  Fig. 5 74-year-old female patient with known lung cancer and metastatic involvement of left iliac bone. Patient was in clinical remission for two years after last treatment. A. Axial fat-saturated T2WI reveals hypointense, focal parenchymal mass (arrow) in subcortical part of right kidney. B. Corresponding DWI sequence image shows intense diffuse restriction at location of mass (arrow). Patient refused percutaneous biopsy at that point, and she was placed on close imaging surveillance. C. Axial fat-saturated T2WI obtained 3 months after first scan revealed interval enlargement of lesion (arrow). D. Corresponding DWI clearly demonstrates focally increased signal suggestive of diffusion restriction (arrow). Percutaneous biopsy confirmed metastatic nature of this lesion. E. Apparent diffusion coefficient map confirms true diffusion restriction by demonstrating significant hypointensity at site of lesion (arrow). DWI = diffusion-weighted imaging, T2WI = T2-weighted image

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  Fig. 6 64-year-old female with known breast cancer and multiple metastases in liver. A. Axial contrast-enhanced CT reveals nodular wall thickening in left renal pelvis (arrow) with intense contrast enhancement. Also note multiple metastases in liver. B. Axial post-contrast T1-weighted image also demonstrates abnormal irregular wall thickening (arrow) with associated brisk contrast enhancement. Urine cytology confirmed uroepithelial metastasis.

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  Fig. 7 65-year-old male with known lung cancer with widespread solid organ and peritoneal involvement in abdomen. Axial contrast-enhanced CT shows bilateral numerous perirenal solid masses (arrows), more prominent on right, consistent with metastases.

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  Fig. 8 55-year-old female patient with known gastric cancer and vertebral metastases presenting with right flank pain. A. Axial contrast-enhanced CT demonstrates newly developed pelvicalyceal dilatation in right kidney. Axial (B) and coronally reformatted (C) CT images demonstrate nodular contrast enhancement in lower third of right ureter (arrows). D. Axial contrast-enhanced CT image demonstrated interval enlargement of same lesion (arrow) 4 weeks after index CT and endo-urological biopsy confirmed gastric cancer as primary source.

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  Fig. 9 64-year-old female with known breast cancer who was in clinical remission for last 5 years. She was referred for annual follow-up CT and was asymptomatic at time of scan. A. Axial venous phase scan demonstrates moderate-severe hydroureteronephrosis (arrow), with significant loss of renal parenchyma, on left kidney. B. Axial venous phase scan demonstrates faint enhancement of lower left ureter (arrow). This was transition point of left dilated ureter. C. Enhancement becomes more pronounced on urographic phase image (arrow). Endo-urologic biopsy confirmed non-neoplastic cells but amyloid deposit.

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  Fig. 10 61-year-old female with known RCC and retroperitoneal lymph node metastases presenting with hematuria. A. Axial contrast-enhanced CT image demonstrates polypoid lesion located close to left ureteral orifice (arrow). There was no evidence of hydronephrosis in left kidney on upper level images (not shown). B. Axial urographic phase image clearly shows filling defect (arrow) created by same polypoid lesion. Cystoscopic biopsy confirmed metastatic RCC. RCC = renal cell cancer

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  Fig. 11 Bladder metastasis in 74-year-old female with known breast cancer, which was last treated 10 years ago; she was in clinical and imaging remission since then. She recently presented with polyuria and gross hematuria. A. Bilateral dilatation of renal collecting system is seen on axial contrast-enhanced CT image. B. Axial contrast-enhanced CT image demonstrates asymmetric thickening (arrows) in left lateral wall of bladder. Chest CT was also negative. Cystoscopic biopsy confirmed metastatic breast cancer.

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  Fig. 12 Urethral metastasis in 57-year-old male with known neuroendocrine tumor of bladder and no known metastasis elsewhere. A. Axial urographic phase CT image shows asymmetric wall thickening (arrows) in anterior bladder wall. Cystoscopic biopsy revealed neuroendocrine tumor of bladder. B. Axial post-contrast CT image of same patient, who presented with difficult urination. CT image demonstrates extensive tumor infiltration (arrow) in penile shaft and ureter (also note urinary drainage catheter-*). Endo-urologic biopsy confirmed metastatic neuroendocrine tumor.

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