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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 69-71

Primary renal squamous cell carcinoma: A case report and literature review


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 Submission01-Oct-2020
Date of Acceptance14-Dec-2020
Date of Web Publication20-May-2021

Correspondence Address:
Dr. Ali B Umar
Department of Pathology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_42_20

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  Abstract 


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

How to cite this URL:
Ahmad AM, Umar AB, Ali SA. Primary renal squamous cell carcinoma: A case report and literature review. Arch Int Surg [serial online] 2020 [cited 2021 Jun 14];10:69-71. Available from: https://www.archintsurg.org/text.asp?2020/10/2/69/316493




  Introduction Top


Squamous cell carcinoma (SCC) of the urinary tract occurs predominantly in the urinary bladder.[1] However, primary renal squamous cell carcinoma (RSCC) of the kidney is rare with a prevalence of 8% amongst all renal cancers.[2] 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 Top


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 Top


Globally, cancers of the kidney and pelvis rank as the 9th most common and the 12th in terms of cancer mortality.[3] Urothelial cancers are the most prevalent in this site; accounting for 90%–95% of cases.[2] RSCCs are rare. Studies on the prevalence of RSCCs are hampered by mostly occasional case reports and case series in the literature.[4],[5],[6] However, a study by Li and Cheung analyzing a large sample size found that they constitute 8% of all renal malignancies.[2]

In Nigeria, RSCC has been reported in some studies of urothelial tumors in general[7],[8] and a case also reported in Adamawa by Raheem et al.[9]

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.[2],[5]

The mean age of presentation has been reported to be 56 years.[2] Our index case is 61 years, and this is consistent with several reports.[10],[11] 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.[4] 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.[12],[13],[14] Our index case, in keeping with this also presented with pT3 stage disease.


  Conclusion Top


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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lopez-Beltran A, Sauter G, Gasser T, Hartman A, Schmitz-Grager BJ, Helpap B, et al. In: Eble JN, Sauter G, Epstein JI, Sesterheinn IA. WHO Pathology and Genetics of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2004. p. 88-157.  Back to cited text no. 1
    
2.
Li MK, Cheung WL. Squamous cell carcinoma of the renal pelvis. J Urol 1987;138:269-71.  Back to cited text no. 2
    
3.
Surveillance, Epidemiology and End Results Program. Cancer Stat Facts: Kidney and Renal Pelvis Cancer. Maryland: National Cancer Institute; 2020. Available from: https://seer.cancer.gov/statfacts/html/kidrp.html. [Cited on 2020 Nov 25].  Back to cited text no. 3
    
4.
Jain A, Mittal D, Jindal A, Solanki R, Khati S, Parikh A, et al. Incidentally detected squamous cell carcinoma of renal pelvis in patients with staghorn calculi: Case series with review of the literature. ISRN Oncol 2011;2011:620574.  Back to cited text no. 4
    
5.
Panessa J, Beck H, Cook S. Squamous cell carcinoma of the renal pelvis associated with kidney stones: A case report. Med Oncol 2011;(Suppl 1):S392-4. doi: 10.1007/s12032-010-9704-z.  Back to cited text no. 5
    
6.
Holmang S, Lele SM, Johansson SL. Squamous cell carcinoma of renal pelvis and ureter: Incidence, symptoms, treatment and outcome. J Urol 2007;178:51-6.  Back to cited text no. 6
    
7.
Badmus TA, Salako AA, Arogundade FA, Sanusi AA, Adesunkanmi AR, Oyebamiji EO, et al. Malignant renal tumors in adults: A ten-year review in a Nigerian hospital. Saudi J Kidney Dis Transpl 2008;19:120-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Efuru V, Ekeke N, Obiora C. Genitourinary malignancies in Port Harcourt, Nigeria. Port Harcourt Med J 2017;11:10-4.  Back to cited text no. 8
    
9.
Raheem N, Abdullahi M, Ngadda HA. Squamous cell carcinoma of the kidney: A consequence of longstanding staghorn calculus. Niger J Basic Sci 2020;17:68-70.  Back to cited text no. 9
    
10.
Payandeh M, Sadeghi E. Squamous cell carcinoma of the renal pelvis: Rare case report. Am J Cancer Prev 2016;4:54-6.  Back to cited text no. 10
    
11.
Jongyotha K, Sriphrapradang C. Squamous cell carcinoma of the renal pelvis as a result of a long standing staghorn calculi. Case Rep Oncol 2015;8:399-404.  Back to cited text no. 11
    
12.
Busby JE, Brown GA, Tamboli P, Kamat AM, Dinney CP, Grossman HB, et al. Upper urinary tract tumors with nontransitional histology: A single-center experience. Urology 2006;67:518-23.  Back to cited text no. 12
    
13.
Blacher EJ, Johnson DE, Abdul-Karim FW, Ayala AG. Squamous cell carcinoma of renal pelvis. Urology 1985;25:124-6.  Back to cited text no. 13
    
14.
Holmang S, Johansson SL. Impact of diagnostic and treatment delay on survival in patients with renal pelvic and ureteral cancer. Scand J Urol Nephrol 2006;40:479-84.  Back to cited text no. 14
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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