Grand RoundsSquamous Cell Carcinoma of the Renal Pelvis
Section snippets
Case Presentation
The patient is a 46-year-old female with a history of chronic kidney disease and bilateral nephrolithiasis status post extracorporeal shockwave lithotripsy and multiple endoscopic procedures who presented with a malignancy of unknown origin. Approximately 1 month before her current admission, the patient underwent an elective right percutaneous nephrolithotomy. Three weeks after her discharge, the patient presented to an outside hospital with fever, chills, vomiting, and abdominal pain. She was
Differential Diagnosis
Our differential diagnosis included xanthogranulomatous pyelonephritis (XGP), SCC, pyonephrosis, chronic pyelonephritis, and a renal cell carcinoma with paraneoplastic syndrome. Also, renal replacement lipomatosis was a consideration.
XGP is an atypical chronic bacterial pyelonephritis that can mimic renal cell carcinoma radiographically.1 Microscopically, lipid-laden macrophages are the predominant cell in this reactive tissue lesion. The disease is not infrequently associated with diabetes
Management, Pathologic Review, and Outcome
Because extensive laboratory and imaging evaluation failed to reveal another potential source for the patient's leukocytosis and fevers, the patient's right kidney became the presumed etiology for her clinical presentation. The patient failed to improve with conservative management, and ultimately she underwent a right open nephrectomy.
Intraoperatively, 1200 mL of ascitic fluid was aspirated on entry into the peritoneum. Extensive perirenal inflammation required significant time for
Discussion by Mark A. Wille, M.D.
Tumors of the renal pelvis are rare when compared with renal cell carcinoma and urothelial carcinoma (UC) of the bladder. Upper urinary tract urothelial tumors account for 5%-7% of all renal tumors and approximately 5% of all urothelial tumors.5 Most renal pelvic and ureteral carcinomas are UC, but 6%-15% are SCC.6, 7 The urothelium can display a wide range of metaplastic changes, and neoplasms arising from this epithelium can show several types of differentiation, especially in high-grade
Conclusion
SCC of the renal pelvis is a rare upper tract UC that is frequently associated with urolithiasis and presents a diagnostic challenge to the urologist. It should form part of the differential diagnosis of those patients who have a clinical picture of XGP or other infectious processes associated with stone disease. The authors recommend surgical management early in the course of the disease if the patient can tolerate it. As more cases are presented in the literature, urologists stand to gain a
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Cited by (17)
Primary squamous cell carcinoma of the renal pelvis presenting with severe hydronephrosis: A rare case report
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2022, International Journal of Surgery Case ReportsCitation Excerpt :Primary SCC arising in the urinary tract is an uncommon neoplasm, and the urinary bladder and male urethra are more frequent sites of SCC than the kidney [11]. Until recently, SCC of the urinary tract was considered to arise from a process of metaplasia, particularly keratinizing squamous metaplasia of the urothelium [8,12]. In the presence of coexisting urothelial dysplastic lesions, including urothelial CIS, the tumor should be diagnosed as urothelial carcinoma with squamous differentiation.
Locally Invasive Primary Squamous Cell Carcinoma of the Left Ureter in a Patient with a Duplicated Inferior Vena Cava
2019, UrologyCitation Excerpt :Additionally, she had none of the commonly known risk factors of upper tract SCC such as history of recurrent nephrolithiasis, phenacetin abuse, or pelvic radiation. Most of the literature on these risk factors is based on relatively few case reports.2-5 Additionally, these risk factors are all associated with chronic inflammation which may predispose to tumorigenesis.6
Renal squamous cell carcinoma mimicking xanthogranulomatous pyelonephritis: Case report and review of literature
2016, Radiology Case ReportsCitation Excerpt :Adjuvant chemotherapy and radiotherapy can be given in advanced renal SCC but have not shown survival benefits [11]. The 5-year survival rate for advanced renal SCC is less than 10% with the median survival time of 5 months [12]. This case report serves to highlight that the diagnosis of malignancy, in particular renal SCC should be considered in a patient having long-standing history of urolithiasis presenting with renal mass.
Incidentally detected primary squamous cell carcinoma of the kidney: Case series with review of the literature
2023, Journal of Cancer Research and TherapeuticsA case report: a renal squamous cell carcinoma presenting as a nephrocutaneous fistula
2023, African Journal of Urology
Financial Disclosure: The authors declare that they have no relevant financial interests.