Squamous Cell Carcinoma of the Kidney – Rarity Redefined: Case Series with Review of Literature

Vishwajeet Singh

doi:10.4172/1948-5956.1000028

Abstract

Squamous cell carcinoma of the renal pelvis and ureter is a rare malignancy, having an incidence of 6% to 15% (of all urothelial tumors). Few cases of primary squamous cell carcinoma of kidney have been reported in the world literature. The insidious onset of symptom and lack of any pathognomonic sign, leads to delay in the diagnosis and subsequent treatment, resulting in grave prognosis for these patients. Herein, we report 5 cases (three males and two females) of advanced primary squamous cell carcinoma of kidney that were treated at our centre during the last 6 years. The average age was 57 years (range 50-65 years). Three of the patients had history of long standing renal calculus disease while 3 had history of smoking and 1 patient had history of analgesic abuse. These cases were unique because in few of them; all the calyces were involved by the tumor - a field change type of pattern normally seen in transitional cell carcinoma of the kidney. In one patient, thrombus of the inferior vena cava was also present along with infi ltration of the duodenum by the tumor. Despite prompt nephroureterectomy, 4 out of 5 patients died within 6 months of treatment. Only one patient was surviving at 5 months of follow up. Nephrectomy with or without ureterectomy is the treatment of choice in patients suffering from squamous cell carcinoma of the kidney. There is lack of evidence of survival benefi ts of chemo-radiation following surgery but is advocated by some with the hope that it might increase survival. Biopsy from the renal pelvis or calyceal wall is advocated at the time of stone removal in patients having long-standing history of large renal calculi or staghorn calculus since such patients are capable of harboring occult or overt malignancy.

Highlights

Squamous cell carcinoma (SCC) of the renal pelvis and ureter is rare with an incidence of 6% to 15% of all urothelial tumors (Blacher et al, 1985; Li and Cheung, 1987; Holmang et al, 2007)
Our current knowledge of squamous cell carcinoma is based on few case reports (Blacher et al, 1985; Li and Cheung, 1987; Holmang et al, 2007; Gahagan and Reed, 1949; Booth et al, 1980)
Nephrectomy with ureterectomy is the treatment of choice in these patients

Summary

Introduction

Squamous cell carcinoma (SCC) of the renal pelvis and ureter is rare with an incidence of 6% to 15% of all urothelial tumors (Blacher et al, 1985; Li and Cheung, 1987; Holmang et al, 2007). The referral operative details mentioned a hard kidney mass which was infiltrating the psoas muscle She was investigated further at our centre; CECT scan of the abdomen showed a left heterogeneous renal mass with 3 cm calculus in the kidney. CECT scan abdomen revealed a large renal mass (right), large multiple retroperitoneal lymph nodes, possibility of invasion of the duodenum and thrombus in the inferior vena cava (Figure 3a and 3b). CT scan of abdomen showed right hydronephrotic kidney with thin renal parenchyma and a heterogeneous mass at the lower pole with few enlarged lymph nodes near the renal hilum. He was managed by right radical nephrouretrectomy. Patient died after 4 months of surgery because of metastatic disease

Findings

Discussion

Conclusion