|Year : 2020 | Volume
| Issue : 2 | Page : 69-71
Primary renal squamous cell carcinoma: A case report and literature review
Abdullahi M Ahmad1, Ali B Umar1, Sani A Ali2
1 Department of Pathology Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
2 Department of Surgery, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
|Date of Submission||01-Oct-2020|
|Date of Acceptance||14-Dec-2020|
|Date of Web Publication||20-May-2021|
Dr. Ali B Umar
Department of Pathology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano
Source of Support: None, Conflict of Interest: None
Squamous cell carcinoma is an aggressive but rarely diagnosed cancer of the kidney. Most cases occur in association with renal calculi and thus require a high index of suspicion for their diagnosis. Though aggressive, it usually presents at a late stage and has an average 5-year survival rate of less than 10%. This is a case report of a 61-year-old male who presented with right flank pain and swelling of 4 years duration and fever and weight loss for 4 months. There was no hematuria and urinalysis and serum chemistry were within normal limits. A tumor in the right kidney was identified clinically and by computerized urography (CTU). At nephrectomy, multiple stones, hydronephrosis and pyonephrosis were found in addition to the tumor in the right kidney. Histological examination revealed squamous cell carcinoma of the kidney.
Keywords: Renal calculi, renal cancer, renal squamous cell carcinoma
|How to cite this article:|
Ahmad AM, Umar AB, Ali SA. Primary renal squamous cell carcinoma: A case report and literature review. Arch Int Surg 2020;10:69-71
| Introduction|| |
Squamous cell carcinoma (SCC) of the urinary tract occurs predominantly in the urinary bladder. However, primary renal squamous cell carcinoma (RSCC) of the kidney is rare with a prevalence of 8% amongst all renal cancers. The rarity of this tumor is compounded by the fact that most cases are only found incidentally, the diagnosis mostly made postoperatively. It is mostly associated with chronic renal stones.
We report a case of primary RSCC in a patient Who had a long standing case of renal calculi.
| Case Report|| |
A 61-year-old male presented with complaints of recurrent right flank pain and swelling of 4 years duration, recurrent fever, and weight loss of 4 months duration. External examination of the abdomen revealed a right flank mass that was ballotable and extending 10 cm below the costal margin along the midclavicular line.
The urinalysis and blood chemistry were within normal reference values.
Computerized tomography intravenous urography (CT IVU) revealed an enlarged right kidney with marked dilatation of its collecting system, multiple calculi, and a single huge hypodense mass in the central aspect. The left kidney appeared normal.
The patient underwent a right nephrectomy on account of hydronephrosis secondary to obstruction by renal calculi.
Intraoperatively, there was massive right pyonephrosis with a staghorn calculus lodged in the renal pelvis.
Grossly, the submitted right kidney was enlarged, measured 21 × 9 × 6 cm, and weighed 520 g. The cut section showed a dilated pelvicalyceal system with some areas having a thickened wall. There was a solid mass with greyish-white cut surfaces measuring 6 cm in widest diameter. There were in addition several small irregular dark brown stones with staghorn patterns and diameters varying from 0.3 to 0.6 cm [Figure 1].
|Figure 1: Multiple cystic cavities with intervening solid areas and dark brown calculi of diameters varying from 0.3 to 0.6 cm|
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The microscopic examination showed almost complete effacement of the renal architecture by infiltrating sheets and nests of well-differentiated malignant squamous cells elaborating keratin pearls and evoking intense stromal inflammation. Atrophic renal tubules filled with eosinophilic casts were also noted in addition to the extension of the tumor cells into the perirenal fat [Figure 2] and [Figure 3].
|Figure 2: Infiltrating sheets and nests of well-differentiated malignant squamous cells evoking stromal desmoplasia|
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|Figure 3: Infiltrating malignant squamous cells with stromal desmoplasia (H&E X400)|
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| Discussion|| |
Globally, cancers of the kidney and pelvis rank as the 9th most common and the 12th in terms of cancer mortality. Urothelial cancers are the most prevalent in this site; accounting for 90%–95% of cases. RSCCs are rare. Studies on the prevalence of RSCCs are hampered by mostly occasional case reports and case series in the literature.,, However, a study by Li and Cheung analyzing a large sample size found that they constitute 8% of all renal malignancies.
In Nigeria, RSCC has been reported in some studies of urothelial tumors in general, and a case also reported in Adamawa by Raheem et al.
As regards etiology, RSCC have been found to be associated with chronic irritation by renal stones as well as chronic infection. The theory is that, these chronic irritative conditions associated with inflammation lead to the development of squamous metaplasia, which later transforms into SCC.,
The mean age of presentation has been reported to be 56 years. Our index case is 61 years, and this is consistent with several reports., The older age associated with this cancer probably has to do with the specific etiology of long-standing chronic irritation.
In most cases reported, the diagnosis of SCC is not made preoperatively; it is only made during the histopathologic examination of the excised kidney. This is attributed to the insidious and nonspecific symptoms the patients present with, which overlaps with those of renal stones. Other reasons include nonspecific radiological findings as well as the biologic growth pattern of this tumor; which in most cases does not produce an exophytic mass that will be easily detected on radiologic examination. In our case, the tumor produced a mass as well as thickened renal pelvis. This made its detection much easier preoperatively. However, the long duration of symptoms might have contributed to this by allowing the tumor to grow to such a large size.
The need to monitor patients with chronic renal stones cannot be overemphasized. This is more so because, as has been noted, conventional ultrasound scan might not in most cases pick up this tumor due to its most unique pattern of growth. The more specific investigation of CT scan cannot be done routinely owing to its comparatively high cost and unavailability.
However, in our case, there was a huge mass that was detected radiographically, which prompted the suspicion of a renal tumor.
Patients with primary RSCC have been noted to present at an advanced stage of their disease that accounts for their poor prognosis.,, Our index case, in keeping with this also presented with pT3 stage disease.
| Conclusion|| |
Primary RSCC is a rare but aggressive tumor that usually presents in an advanced stage and is commonly associated with chronic renal calculi. It thus requires a high index of suspicion for early recognition and management
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]