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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 68-70

Squamous cell carcinoma of the kidney: A consequence of longstanding staghorn calculus


1 Department of Histopathology, Federal Medical Centre, Yola, Adamawa State, Nigeria
2 Department of Surgery, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Histopathology, University of Maiduguri Teaching Hospital, Bornu State, Nigeria

Date of Submission02-May-2018
Date of Acceptance08-Jun-2018
Date of Web Publication30-May-2020

Correspondence Address:
Dr. Muzzammil Abdullahi
Department of Surgery, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_19_18

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  Abstract 


Squamous cell carcinoma (SCC) of the kidney is a rare and an aggressive tumor with a 5-year survival rate of <10%. They are usually associated with staghorn calculi and diagnosed at an advanced stage due to the rarity and inconclusive clinical and radiological features. We present a case of 54-year-old man histologically diagnosed of SCC of the kidney following nephrectomy. He had antituberculous drugs for 4 months on account of history of chronic cough, weight loss, and intermittent fever of 1-month duration. This case merits being reported because this aggressive cancer would have been prevented if the stone had been detected and removed early with biopsy taken from renal pelvis or calyceal wall.

Keywords: Carcinoma, squamous cell, staghorn calculus


How to cite this article:
Raheem N, Abdullahi M, Nggada HA. Squamous cell carcinoma of the kidney: A consequence of longstanding staghorn calculus. Niger J Basic Clin Sci 2020;17:68-70

How to cite this URL:
Raheem N, Abdullahi M, Nggada HA. Squamous cell carcinoma of the kidney: A consequence of longstanding staghorn calculus. Niger J Basic Clin Sci [serial online] 2020 [cited 2020 Aug 7];17:68-70. Available from: http://www.njbcs.net/text.asp?2020/17/1/68/285465




  Introduction Top


Primary squamous cell carcinoma (SCC) of the renal pelvis is an extremely rare entity representing only 0.5–15% of all urothelial malignancies.[1],[2],[3] The incidence is 1.4% of all renal malignancies.[2] It is clinically unsuspected due to its rarity and inconclusive clinical and radiological features.[1] Solid mass, hydronephrosis, and calcifications are common but nonspecific radiological findings, which may further explain why diagnosis is not frequently established before the histopathological examination of the resected surgical specimen.[3] These tumors are highly aggressive, high grade, and locally advanced or metastatic at the time of presentation related to poor prognosis.[2] It usually occurs between the age range of 50 and 70 years.[2],[4] Staghorn calculi are branched calculi that fill the entire or part of the renal pelvis and extend into the renal calices. If untreated or inadequately treated, they may lead to various complications such as deterioration of renal function and risk of developing urosepsis. Furthermore, chronic irritation, inflammation, and infection from these stones can cause squamous metaplasia of the renal pelvis epithelium that may progress to SCC.[4]


  Case Report Top


A 52-year-old man first presented to us with a 1 year history of recurrent left flank pain, which was dull and radiating to the back. The pain worsened about 5 months prior to presentation with intermittent fever. However, there was no history of lower urinary tract symptoms, hematuria, or passage of stone in the urine. Patient was diagnosed of pulmonary tuberculosis about 4 months prior to presentation on account of chronic cough, weight loss, and intermittent fever all for 1 month. He was started on antituberculosis drug regimen, which he took for 4 months prior to presentation during which the cough subsided. However, the other symptoms persisted. No uremic symptoms at presentation.

Investigations done showed a normal hemogram, raised erythrocyte sedimentation rate (50 mm/h), normal serum urea, electrolytes, and creatinine. Abdomino-pelvic ultrasound scan showed grade III hydronephrosis and renal calculus measuring 2.2 × 1.2 cm. Intravenous urography showed normal functioning right kidney, nonfunctioning left kidney, and Grade IV obstructive uropathy due to staghorn calculus [Figure 1]. The left ureter was not visualized. Computerized tomographic scan and renal scintigraphy were not done due to nonavailability of the facilities in our center.
Figure 1: Intravenous urography (IVU) showing non- functioning left kidney and staghorn calculus

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A clinical diagnosis of left staghorn calculus with nonfunctioning kidney was made. Patient was prepared and had renal exploration through the left flank incision, which was later extended transperitoneally to assess the peritoneal organs. The right kidney was grossly normal; however, the left kidney was grossly enlarged containing pus. There was no healthy renal tissue. Hence, total nephrectomy was done and patient did well postoperatively.

Gross findings include a distorted grey white tissue measuring 15 × 12 × 8 cm and weigh 550 g. No identifiable renal tissue except the adrenal gland. Cut sections revealed a highly necrotic tumor with hemorrhage and multiple cystic areas containing light green gelatinous materials.

Histology showed nests of malignant squamous cells having prominent intercellular bridges and keratin pearls formation almost completely effacing renal parenchymal with only few recognizable glomeruli and renal tubules left [Figure 2]. The adrenal gland was, however, unremarkable. Diagnosis of well-differentiated SCC was made based on these findings. Patient later developed pain along incision site, which was treated with analgesics following evaluation. He is presently doing well 6 months after surgery.
Figure 2: Photomicrograph showing renal glomerulus (large arrow) and atrophic tubules (small arrow)

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  Discussion Top


The most common tumor originating from renal pelvis is transitional cell carcinoma followed by SCC and adenocarcinoma.[5],[6] Primary SCC of the renal pelvis, most of which is known to arise from collecting system but secondarily invades the renal sinus fat and renal parenchyma is an extremely rare entity representing only 0.5–15% of all urothelial malignancies.[1],[2],[3],[7] The incidence is 1.4% of all renal malignancies.[2] It is clinically unsuspected due to its rarity and inconclusive clinical and radiological features.[1] It usually occurs between the age range of 50–70 years.[2],[4] Recent literatures show that men bear a higher incidence of renal SCC, probably because of higher incidence of nephrolithiasis in them.[8] Clinical manifestations include abdominal or flank pain, hematuria, and abdominal mass. Although renal pelvic tumors are almost never palpable clinically but they may block the urinary out flow and lead to palpable hydronephrosis.[9] The coexistence of renal calculi with SCC has been reported in 87–100% of cases.[4],[10] It has also been found to be associated with tuberculosis, chronic pyelonephritis, radiation therapy, chronic rejection in a transplanted kidney, analgesic abuse with phenacetin, immunosuppression with azathioprine, and previous percutaneous nephrolithotomy.[4],[8]

Staghorn calculi are branched calculi that fill the entire or part of the renal pelvis and extend into the renal calices. If untreated or inadequately treated, they may lead to various complications such as deterioration of renal function and risk of developing urosepsis. Furthermore, chronic irritation, inflammation, and infection from these stones can cause squamous metaplasia of the renal pelvis epithelium that may progress to SCC.[4]

The imaging modality of choice for renal diseases evaluation is conventional ultrasonography, but renal SCC lacks specific echoic pattern. Computed tomography (CT) scan may play a crucial role in diagnosis and staging of the tumor. The most helpful feature in CT of renal SCC is presence of enhancing extraluminal and exophytic mass in some cases, with an intraluminal component.[8]

The main differential diagnosis of renal SCC is xanthogranulomatous pyelonephritis (XGP), an entity which is also associated with renal calculi. It is an uncommon form of chronic pyelonephritis resulting from chronic obstruction usually from renal calculi, which leads to hydronephrosis, formation of an inflammatory mass causing destruction of renal parenchyma, mimicking malignancy.[7] A typical feature of XGP on contrast-enhanced CT is the bear-paw sign seen as low-attenuating areas surrounded by enhancing thinned-out renal parenchyma from chronic hydronephrosis. However, this may not always be seen. Moreover, XGP can invade adjacent structures, similar to an aggressive malignancy.[7]

Nephrectomy is regarded as the mainstay of treatment for primary SCC of the kidney. Most cases usually present at an advanced stage-pT3 or higher. Therefore, for the treatment of advanced disease, a multidisciplinary approach comprising surgical treatment and adjuvant chemoradiotherapy should be applied.[8] However, poor response to surgery, radiotherapy, and chemotherapy is the norm, resulting in short survival periods for most of the cases.[11]


  Conclusion Top


SCC of the kidney is a rare and an aggressive tumor usually associated with staghorn calculi. Early detection and removal of the stone with biopsy taken from the renal pelvis will go a long way in preventing this form of cancer.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sahoo TK, Das SK, Mishra C, Dhal I, Nayak R, Ali I, et al. Squamous cell carcinoma of kidney and its prognosis: A case report and review of the literature. Case Rep Urol 2015;2015:6-9.  Back to cited text no. 1
    
2.
Payandeh M, Sadeghi 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. 2
    
3.
Singh V, Sinha RJ, Sankhwar SN, Mehrotra B, Ahmed N, Mehrotra S. Squamous cell carcinoma of the kidney – Rarity redefined: Case series with review of literature. J Cancer Sci Ther 2010;2:82-5.  Back to cited text no. 3
    
4.
Jongyotha K, Sriphrapradang C. Squamous cell carcinoma of the renal pelvis as a result of long-standing staghorn calculi. Case Rep Oncol 2015;8:399-404.  Back to cited text no. 4
    
5.
Samanta DR, Chaitali B, Sasmita P, Ashis U, Abhijit D, Senapati SN. Primary squamous cell carcinoma of kidney: Report of two cases. Int J Med Res Health Sci 2015;4:916-8.  Back to cited text no. 5
    
6.
Ayhan K, Levent E, Mehmet G, Nazmi İ, Cankon G, Demokan E. Squamous cell carcinoma located in the renal caliceal system: A case report and review of the literature. Turkish J Cancer 2002;32:20-4.  Back to cited text no. 6
    
7.
Khoo HW, Lee CH. Renal squamous cell carcinoma mimicking xanthogranulomatous pyelonephritis: Case report and review of literature. Radiol Case Rep 2016;11:74-7.  Back to cited text no. 7
    
8.
Jiang P, Wang C, Chen S, Li J, Xiang J, Xie L. Primary renal squamous cell carcinoma mimicking the renal cyst: A case report and review of the recent literature. BMC Urol 2015;15:1-4.  Back to cited text no. 8
    
9.
Domblae V, Gundalli S, Prabhu M, Sonali S. Primary squamous cell carcinoma kidney: A rare case report. Our Dermatol Online 2016;7:45-7.  Back to cited text no. 9
    
10.
Çetindaǧ MF, Özsavran AY. Primary renal squamous cell carcinoma: A case report. Türk Onkol Derg. 2015;30:74-7.  Back to cited text no. 10
    
11.
Kumar S, Tomar V, Yadav SS, Udawat H, Priyadarshi S, Vyas N, et al. Primary squamous cell carcinoma of kidney associated with large calculus in non-functioning kidney: A case report. Urol Case Rep 2016;8:4-6.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

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