A population-based study of tumours of the renal pelvis and ureter: Incidence, aetiology and histopathological findings

Abstract

Objective. Carcinoma of the renal pelvis and ureter are unusual tumours and our limited knowledge comes mainly from case reports and small series from large academic hospitals, as a rule without histopathological review. This study reports aetiological and demographical factors as well as clinicopathological findings of all patients in a large geographical region. Material and methods. All patients in western Sweden with a renal pelvic or ureteral tumour diagnosed between 1971 and 1998 (n = 930) were included. Untreated cases were not excluded. Demographic data and results of preoperative examinations were retrieved from the original clinical records. The histopathological slides were reviewed and tumour stage, grade, configuration, presence of carcinoma in situ and angiolymphatic invasion were determined Results. The majority of patients (80%) had invasive or high-grade tumours. Carcinoma in situ was present among 30% of patients with non-invasive high-grade tumours. Angiolymphatic invasion (62%) and solid (non-papillary) growth pattern (84%) were very common among patients with stage T2–T4 tumours. Twenty-three women out of 138 (16.7%) with ureteral carcinoma had a history of abdominal radiotherapy for gynaecological cancer 22 years (median) earlier. Forty-one patients out of 930 (4.4%) had a history of abuse of phenacetin-containing analgesics. Conclusions. This study demonstrates a very high incidence of high-grade upper tract tumours with carcinoma in situ, angiolymphatic invasion and solid (non-papillary) growth pattern, which underscores the malignant character of the disease. The possible association between pelvic radiotherapy and ureteral carcinoma warrants further study.

Key Words::

• Aetiology
• diagnosis
• incidence
• renal pelvic cancer
• ureteral cancer
• urothelial cancer

Acknowledgements

We are grateful to our colleagues in the departments of urology, pathology, oncology and surgery in western Sweden for giving us access to clinical records and histopathological material. We also thank Susanne Amsler-Nordin at the Oncology Centre in Sahlgrenska University Hospital for valuable assistance.

Declaration of interest : The authors have received no financial support in connection with this paper.