Elsevier

Urology

Volume 84, Issue 1, July 2014, Pages 8-11
Urology

Grand Rounds
Squamous Cell Carcinoma of the Renal Pelvis

https://doi.org/10.1016/j.urology.2013.11.020Get rights and content

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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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Financial Disclosure: The authors declare that they have no relevant financial interests.

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