Abstract
Pancreas carcinoma is sometimes notoriously difficult to diagnosis. Although it is well known that pancreas carcinoma can invade contiguous organs, no attention for urinary tract involvement is paid. Although urinary tract is usually involved at a late stage, it may represent the first symptomatic evidence of the disease. In such case pancreas carcinoma can present initially as urologic disease and patients' symptom may not be differentiated from urinary tract disease. Computed tomography (CT) images and medical records of 50 patients with histologically proved pancreas carcinoma were reviewd.
There were 10 patients, 8 males 2 females, with urinary tract involvement. Eight of those patients were studied by IVP. There was a high incidence of left urinary tract involvement (right:left:bilateral=2:7:1). All 10 cases were with pancreas body and tail carcinoma in stage IV. All cases were confirmed to have the urinary tract involvement at autopsy within 4 months after CT studies. We compared those IVP, CT images and findings of autopsy.
In those patients, 4 cases showed direct invasion to the kidney, 5 cases showed ureter involvement mainly due to retroperitoneal invasion, and 1 case showed metastasis to the uinary bladder and ureters.
IVP showed inferior displacement of the kidney and/or ureteral displacement on the affected side, collecting system distortion including hydronephrosis secondary to ureteral compression.
CT scan showed abnormal masses which were contiguous to the pancreas and compressed the kidney and/or retroperitoneal extension with ureteral involvement. Metastasis to the urinary bladder was also identified.
The autopsy findings were almost the same as the CT images. Pancreas carcinoma characteristically remains silent until there is little chance for cure. Although urinary tract involvemant is rare, it can mimic renal and ureteral pathology.
The radiologist and urologist must include, in the differential diagnosis of urinary tract lesion, disease process originating in the pancreas as well as in the contiguous organ.
