Large TCC’s may look similar to

• Infiltrating renal cell carcinoma
• Lymphoma
• Metastases
• Xanthogranulomatous pyelonephritis

“The most common imaging manifestation of transitional cell carcinoma in the ureters is urothelial thickening, particularly focal thickening or a short-segment ureteral stricture. Similar to other sites in the urinary tract, diffuse or bilateral urothelial thickening in the ureters is unlikely to represent malignancy, and is much more likely to represent an ascending urinary tract infection (particularly when associated with diffuse bladder wall thickening secondary to cystitis).”
Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography 
Siva P. Raman, MD*, Elliot K. Fishman
Urol Clin N Am 45 (2018) 389–405

“As with other portions of the urinary tract, transitional cell carcinomas in the ureter are often hypovascular, making it critical that the field of view includes the entirety of the ureters during the arterial phase acquisition. Any focal or irregular urothelial hyperenhancement should raise concern for malignancy, and, in some instances, there may be associated tumor neovascularity.”
Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography 
Siva P. Raman, MD*, Elliot K. Fishman
Urol Clin N Am 45 (2018) 389–405

“ The hallmark of TCC is multiplicity and recurrence. Nearly 2-4% of patients with bladder cancer develop upper tract TCC, but 40% of patients with upper tract TCC develop bladder cancer.”
Imaging and Staging of Transitional Cell Carcinoma: Part 2, Upper Urinary Tract
Vikram R et al
AJR 2009;192:1488-1493

Periureteral fat stranding
Extramural spread of tumor

Neovascularity secondary to malignancy

Transition points in the urinary tract secondary to malignancy