Primary carcinoma of the renal pelvis and ureter. Evaluation of clinical and pathologic features.

Thirty-eight cases of carcinoma of the renal pelvis and ureter were evaluated for stage, grade, histologic type, location, presence or absence of vascular invasion, abnormalities in the urothelium adjacent to the tumors, clinical appearance, patient survival, and therapeutic intervention. A good correlation between tumor grade and stage was found in the transitional cell carcinomas. Squamous cell carcinomas were high-stage tumors and transitional cell carcinomas with prominent squamous components were of a higher stage than "pure" transitional cell carcinomas of the same grade. Vascular invasion was present in only high-grade tumors and the squamous cell carcinomas. The degree of atypia present in the urothelium adjacent to the tumors corresponded with the grade of the tumors. Hematuria, with or without associated flank pain, was the most common initial symptom in patients with these neoplasms. Survival was good in stage A neoplasms but poor in higher-stage neoplasms. Appropriate treatment for these tumors remains controversial.