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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
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Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
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The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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Squamous Cell Carcinoma of the Renal Pelvis: Rare Case Report

Mehrdad Payandeh, Masoud Sadeghi, Edris Sadeghi*

Cancer Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract: Primary squamous cell carcinoma (SCC) of the kidney is an extremely rare entity representing only 0.5-15% of all urothelial cancers. Herein, we reported a rare case of renal cell carcinoma with SCC extended to the pelvis. A 56 year-old female patient referred to the oncology clinic with complaints of pain in the right flank. The CT showed a hypodense renal mass of size approximately 2 × 2.1 cm in the upper pole of the right kidney. High grade urothelial carcinoma and squamous cell carcinoma extended to renal capsule, but not pass to perirenal fat. Vascular invasion was present, but perineural invasion was not seen. Ureteral margin was free of tumor. Biopsy showed one hilar lymph node involved with tumor in the near right kidney. A few slightly stones smaller than normal 0.4 × 0.9 cm can be seen in the calyx of the asymptomatic hydronephrosis of left kidney. SCC is one of the rare histological tissues in the kidney and hydronephrosis is the most common complaints in more patients with this malignancy.

Keywords: renal cell carcinoma, SCC, Kidney Stone

Citation: Mehrdad Payandeh, Masoud Sadeghi, Edris Sadeghi, Squamous Cell Carcinoma of the Renal Pelvis: Rare Case Report. American Journal of Cancer Prevention, 4 (4). 54-56. January 2016. doi:10.12691/ajcp-4-4-2

1. Introduction

Primary squamous cell carcinoma (SCC) of the renal pelvis is an extremely rare entity representing only 0.5% to 15% of all urothelial malignancies [1]. The incidence of this tumor is 1.4% of all renal malignancy [2]. These tumors are highly aggressive, high grade, and locally advanced or metastatic at the time of presentation related to poor prognosis [3]. It is clinically unsuspected due to its rarity and inconclusive clinical and radiological features [1]. In this study, we reported a rare case of renal cell carcinoma with SCC extended to the pelvis.

2. Case Presentation

A 56 year-old female patient referred to the oncology clinic with complaints of pain in the right flank. Due to decreasing of renal function undergoing radical nephrectomy, surgery was followed by frozen section. Laboratory tests were normal and purified protein derivative (PPD) skin test was negative except erythrocyte sedimentation rate (ESR) that was positive. The CT scan showed a hypodense renal mass of size approximately 2 × 2.1 cm in the upper pole of the right kidney (Figure 1).

Non-contrast CT scan of the abdomen and pelvic showed a cystic mass with dimension of 7 × 8 cm in lower bridge right kidney and several nodules in its lower part (Figure 2).

High grade urothelial carcinoma and squamous cell carcinoma extended to renal capsule, but not pass to perirenal fat. There was vascular invasion, but perineural invasion was not seen. Ureteral margin was free of tumor. Biopsy showed one hilar lymph node involved with tumor in the near right kidney. A few slightly stones smaller than normal 0.4 × 0.9 cm can be seen in the calyx of the asymptomatic hydronephrosis of the left kidney (Figure 3).

Figure 1. Hypodense renal mass of size approximately 20 × 21 mm in upper pole of right kidney

Figure 2. CT scan demonstrates a large cystic lesion

Figure 3. CT scan showing left renal stones

Liver, spleen and pancreas were normal (Figure 4). Tumor necrosis was 20%. Immunohistochemistry for CK7 and CK20 is done that CK7 was positive, but CK20 was negative.

Figure 4. Kidney tumor image

3. Discussion

SCC in the kidney is very unusual and is known to increase from collecting system [4]. Renal pelvic tumors are almost never palpable clinically; however, they may block the urinary outflow and lead to palpable hydronephrosis. Hydronephrosis is more common in renal tumor than renal pelvic ones [2]. Lanjewar et al. [5] reported a case of primary SCC of the kidney that had no calculus or hydronephrosis, whereas most cases are associated with calculus disease or hydronephrosis that our case had hydronephrosis. A most common age group of presentation is 50 to 70 years [6] like our study that patient had 56 years old. The survival of patients with central renal SCC was reported to be significantly shorter than those with peripheral renal SCC [7]. Diagnosis of renal SCC is difficult as characteristic features usually not associated with renal SCC, added by imaging techniques which revealed only calculi and hydronephrosis [3]. Li et al. [8] reported incidence of coexisting renal stone in 100% cases, like our study. Lee et al. [7] classified these tumors into two groups, according to the localization of the tumors as central and peripheral. Central renal cell carcinoma presents more intraluminal components and is usually associated with lymph node metastasis, whereas peripheral renal SCC presents with prominent renal parenchymal thickening and might invade the perirenal fat tissue before lymph node or distant metastasis could be identified [7]. This case was high grade urothelial carcinoma and SCC extended to renal capsule, but not passing to perirenal fat. Primary treatment of renal SCC is nephrectomy, but adjuvant chemotherapy or radiotherapy indicated in metastatic disease [3]. This tumor tends to present at a more advanced stage [9].

4. Conclusion

SCC is one of the rare histological tissues in the kidney. Hydronephrosis is the most common complaints in more patients with SCC of the renal pelvis that needs to more research in future on the association of between hydronephrosis and this tumor.

Acknowledgement

The authors have no any acknowledgement.

References

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[2]   | Bandyopadhyay R, Biswas S, Nag D, Ghosh AK. Squamous cell carcinoma of the renal pelvis presenting as hydronephrosis. J Cancer Res Ther. 2010;6(4):537-9.
[3]   | Karabulut A, Emir L, Gonultas M, Incel N, Germiyanoglu C and Erol D. Squamous cell carcinoma located in the renal caliceal system: A case report and review of the literature. Turkish J of Cancer. 2002;32(1):20-4.
[4]   | O. Odabas, M. Karakok, Y. Yilmaz, M. K. Atilla, E. Akman, S. Aydin, et al. Squamous cell carcinoma of kidney. Eastern Journal of Medicine. 2000;5(1):35-6.
[5]   | Lanjewar SM, Bodade RM, Bansod AN, Kulkarni A. Primary squamous cell carcinoma of kidney: a case report. Int Surg J.2015;2(1):82-4.5.
[6]   | N. Talwar, P. Dargan, MP Arora, A. Sharma, and AK Sen. Primary squamous cell carcinoma of the renal pelvis masquerading as pyonephrosis: a case report. Indian Journal of Pathology and Microbiology. 2006;49(3):418-20.
[7]   | Lee TY, Ko JF, Wan YL, Cheng YF, Yang BY, Huang DL, et al. Renal squamous cell carcinoma: CT findings and clinical significance. Abdom Imaging. 1998; 23(2):203-8.
[8]   | Li MK, Cheung WL. Squamous cell carcinoma of the kindey. J Urol. 1987;138(2):269-71.
[9]   | Kose F, Bal N, Ozyilkan O. Squamous cell carcinoma of the renal pelvis. Med Oncol. 2009;26(1):103-4.