Abstract
Squamous cell carcinoma of the renal pelvis is a rare neoplasm, often unsuspected clinically due to its rarity and ambiguous clinical and radiological features, and hence patients present at advanced stages resulting in poor prognosis. We report here four cases of incidentally diagnosed primary renal squamous cell carcinoma, treated at our hospital over a short span of one year, and review the relevant literature. Mean age of the patients (3 males, 1 female) was 60 years. All suffered from staghorn stones. Interestingly, renal carcinoma was unsuspected clinically in all patients. In one case, a computerised tomography scan showed a suspicious nodule. All underwent nephrectomy for nonfunctioning kidney. In just two cases, tumor was identified on gross examination, while the other two only showed thickened pelvis. Our series emphasises the need for pelvicalyceal biopsy during treatment for long-standing nephrolithiasis, and thorough sampling of the renal pelvis in nephrectomy specimen of such patients.
Highlights
Primary renal squamous cell carcinoma (RSCC) is a rare cancer with a variable incidence of about 0.5–15% of all urothelial cancers [1,2,3,4]
With the exception of the latter, in whom a suspicious lesion was seen on imaging studies, in all the rest a carcinoma was unsuspected clinically as well as radiologically, and the diagnosis came to light only on histology
Only 5-6% occur in the upper urinary tract, and of these only about 6–15% are squamous cell carcinomas [5]
Summary
Primary renal squamous cell carcinoma (RSCC) is a rare cancer with a variable incidence of about 0.5–15% of all urothelial cancers [1,2,3,4]. We report four cases of incidentally detected renal pelvis squamous cell carcinomas in patients having a history of staghorn renal calculi with hydronephrosis. Three of the patients were operated for renal stones in our hospital while one was referred to us for confirmation of diagnosis and further management. Our series highlights the need for a renal pelvic biopsy and periodic radiological evaluation in patients undergoing treatment for renal stones, as RSCC usually escape detection, with dire consequences for the patient, and are only identified incidentally at late stages, when the patient undergoes surgery for a nonfunctioning kidney
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