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Findings: Retrograde evaluation of the right ureter reveals dilation of the right ureter proximal to partially obstructing mass, demonstrating a stippled appearance after the injection of contrast material.
Diagnosis: Transitional cell carcinoma of the ureter demonstrating the "chalice sign" or Goblet Sign/Bergman’s sign. This appearance is typical of transitional carcinoma of the ureter.
Discussion: Transitional cell carcinoma is responsible for 85% of all uroepithelial tumors. The papillomatous variety is most common accounting for 80% of cases. The stippled appearance noted in this case is due to the trapping of contrast in the tumor interstices of the papillary mass. The remaining 20% represent the infiltrating form, which result in focal thickening of the pelvocalyceal wall and or ureter. Radiographically this may appear as an extrinisc compression. Peak incidence is in the sixth decade and males are involved twice as frequently as females.
Site of ureteral involvement increases from the proximal third (15%) and middle thirds (15%) to 70% involvement of the distal third of the ureter. Multifocal involvement is most common with primary ureteral disease (39%). The incidence decreases to 24% for primary renal transitional cell carcinoma and 2% for primary bladder involvement. Following treatment, follow-up is important to look for new sites. Bladder involvement is more frequent following ureteral tumors than ureteral involvement following bladder primaries.
Several groups of patients are identified as having a higher risk for developing transitional cell carcinoma:
References:
Levine E. The Kidney. In: Computed Tomography and Magnetic Resonance
Imaging of the Whole Body. Haaga JR, et al, Eds. Philadelphia: Mosby; 1994:1219-1221.
Witten DM, Myers GH, Utz DC. Emmett’s Clinical Urography. Philadelphia: W. B. Saunders;
1977:1554-1589.
Dahnert W. Radiology Review Manual 2nd ed. Baltimore: William and Wilkins; 1993: 476-477.
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