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Association of Squamous Cell Carcinoma with Nonfunctioning Kidney due to Renal Stone Disease
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Although the second most common malignancy after urothelial carcinoma, squamous cell carcinoma (SCC) of the renal pelvis is a rare entity. It has strong association with nephrolithiasis thus emphasizing prompt treatment of renal calculi. Because of rarity and nonspecific clinical and radiological findings, it mostly presents at pT3 or higher stage. We report SCC of renal pelvis that was missed two times on non-contrast CT scans and was diagnosed incidentally in a nephrectomy specimen. Its prognosis is similar to that of urothelial carcinoma of comparable stage. Owing to its rarity, no standard treatment guidelines are available; however radical nephrectomy with lymph node dissection is the initial treatment which can be curative in an early stage disease. Adjuvant chemotherapy and radiotherapy are usually ineffective.
Squamous cell carcinoma (SCC) of urinary tract is a rarely encountered tumor. The incidence of this tumor is 1.4 per cent of all renal malignancies (1). We present a case of 52 years male with squamous cell carcinoma of renal pelvis, presenting as chronic pyelonephritis transforming the kidney into non-functioning multicystic cavitatory mass without any renal calculi. The case highlights the rarity of tumor in absence of calculi or any other predisposing factor. Moreover, histology of resected specimen detected features of SCC giving importance to careful and exhaustive assessment of specimen and of histologic sections, when there is no suspicion of malignancy clinically.
Squamous cell carcinoma (SCC) of the renal pelvis is a rare neoplasm and is usually associated with long standing renal stone disease. This tumor is aggressive in nature and usually has a poor prognosis. We report a case who presented with sudden significant weight loss. During the radiologic investigation, a renal mass and staghorn calculi were detected in the right kidney. The patient subsequently underwent right radical nephrectomy. Pathological diagnosis was SCC of renal pelvis with extensive infiltration in to the renal parenchyma. The radiologic imaging features and histopathologic findings of this rare tumor are discussed in this report.
Squamous cell carcinoma of the renal pelvis is a rare neoplasm, often unsuspected clinically due to its rarity and ambiguous clinical and radiological features, and hence patients present at advanced stages resulting in poor prognosis. We report here four cases of incidentally diagnosed primary renal squamous cell carcinoma, treated at our hospital over a short span of one year, and review the relevant literature. Mean age of the patients (3 males, 1 female) was 60 years. All suffered from staghorn stones. Interestingly, renal carcinoma was unsuspected clinically in all patients. In one case, a computerised tomography scan showed a suspicious nodule. All underwent nephrectomy for nonfunctioning kidney. In just two cases, tumor was identified on gross examination, while the other two only showed thickened pelvis. Our series emphasises the need for pelvicalyceal biopsy during treatment for long-standing nephrolithiasis, and thorough sampling of the renal pelvis in nephrectomy specimen of such patients.
Squamous cell carcinoma (SCC) of urinary tract is a very rare tumour known to be associated with chronic renal calculi and infection. This tumour is highly aggressive and often detected at advanced stage with poor outcome. The authors describe a case report of a 62-year-old male patient who was diagnosed with right nephrolithiasis with non-functioning kidney. Histopathology revealed an unexpected co-existing SCC in renal pelvis. The present case highlights the careful search and use of newer imaging modalities in cases of long-standing renal calculi as they may have co-existing hidden malignancy which may change the treatment plan and prognosis.
From 1970 to 1985 we treated 144 cases of malignant tumors of the kidney. Of these patients only 11 (8 per cent) had squamous cell carcinoma of the renal pelvis compared to transitional cell carcinoma of the renal pelvis in 53 per cent, renal cell carcinoma in 37 per cent and other types in 2 per cent. In all patients the squamous cell carcinoma was associated with chronically infected staghorn renal calculi of long duration. The patients usually presented late with extensive local infiltration, making surgical resection difficult. In addition, poor response to surgery, radiotherapy and chemotherapy resulted in a poor prognosis and short survival. A summary of our cases and a review of the literature are presented.
Squamous carcinoma of the renal pelvis was diagnosed in only 11 of 2,166 renal tumors (0.5%) seen over a twenty-seven-year period. The combination of an insidious onset and a prolonged duration of symptoms (median: 5 months) resulted in all patients having invasive disease at diagnosis. Ten patients died two to twenty-eight months after diagnosis (median survival: 5 months), and only 1 patient is currently alive at nine months. We conclude that the treatment of choice is radical nephrectomy followed by adjuvant chemotherapy.
The study was carried at two different centres. Only 9 cases of primary malignant tumours of the renal pelvis could be collected during the period of 7 years (1984-1990). Renal pelvis malignancies constituted 0.21% of all the malignancies and 12.16% of all the malignant growths of the kidney (9 out of 74 cases). The age of these patients ranged from 24 to 70 years; the mean being 41.7 years. Male/female ratio was 8:1. Common triad of complaints (pain, haematuria and lump) was noticed in 22.2% of patients. Individually they were noticed in 77.8%, 66.7% and 44.4% of patients respectively. Transitional cell carcinoma was the commonest, seen in 7 patients (77.8%) whereas squamous cell carcinoma and adenocarcinoma were noticed in one patient (11.1%) each. Hydronephrosis, chronic pyelonephritis and nephrolithiasis were noticed in 66.7%, 44.4% and 22.2% of patients respectively. Ultrastructural study of urothelial tumours revealed tumour cells in various stages of differentiation with loss of intercellular junctions and dense collection of rough endopasmic reticulum fibrils around the nucleus.
Primary Squamous Cell Carcinoma Of Kidney -A Case Report And Review Of Literature
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Source of Support: Nil; Conflict of Interest: None Submitted
- M Raghavendran
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Source of Support: Nil; Conflict of Interest: None
Submitted: 06-12-2019; Accepted: 01-01-2020; Published: 30-01-2020