Advanced Renal Pelvic Carcinoma Revealed after Treatment of a Staghorn Calculus by Endoscopic Combined Intrarenal Surgery

Abstract

Renal pelvis carcinoma associated with staghorn calculus is a clinically rare condition. A 66-year-old man presented with flank pain due to an 8 cm complete staghorn calculus. We performed three lithotomies using endoscopic combined intrarenal surgery and carried out intraoperative biopsy. Histopathological examinations revealed a keratinized lesion. One month later, contrast-enhanced computed tomography showed an advanced renal pelvis carcinoma. These findings demonstrate that even an intraoperative biopsy may be insufficient to diagnose a renal pelvis carcinoma associated with a staghorn calculus. The possibility of RPCa developing when treating a long-standing staghorn calculus should therefore be kept in mind.

Focus on Upper Urinary Tract Stones Combined With Parenchymal Infiltrative Renal Pelvis Cancer

“…Postoperative pathological examinations revealed highgrade uroepithelial carcinoma in every case, including one with squamous metaplasia and two with infiltrative uroepithelial carcinoma of the renal parenchyma. According to some academics, the etiology might go somewhat like this: (1) squamous epithelial metaplasia and cancer are brought on by long-term stone and infection irritation of the mucosa of the renal pelvis and calyces; (2) urinary epithelial cells grow abnormally under the influence of stones and infection over time, eventually developing into uroepithelial cancer; and (3) after the combination of stones and obstruction, urogenic carcinogens cannot be eliminated over time, and carcinogenesis develops in the mucosa as a result of prolonged activity [5,18].…”

“…Patients who have a lengthy history of stones or cast stones should be informed that coupled renal pelvic cancer is a potential risk. It is necessary to observe the patient carefully during percutaneous nephrological or ureteroscopic examination, and a sufficient volume of aberrant mucosa should be sampled at numerous points of the procedure to minimize the risk of a missed diagnosis [5]. Given the low prevalence of positive intraoperative samples, preoperative urine exfoliative cytology in high-risk patients must be combined, and aberrant findings must receive enough attention [4,22].…”

A Case of Squamous Cell Carcinoma of Kidney Manifesting After Percutaneous Nephrolithotomy for Renal Pelvic Calculi

“…Histological examination of the skin mass showed an invasive well-differentiated squamous cell carcinoma. There is almost a similar case of a 50 years old male who underwent radical surgery for urothelial carcinoma of the lower pole of the kidney detected 2 weeks after PCNL for renal pelvic calculus 10 . SCC of the renal pelvis produces nonspecific clinical and radiological features.…”

“…Differential diagnoses for renal squamous cell carcinomas are urothelial carcinomas and xanthogranulomatous pyelonephritis. To make a correct diagnosis, an extensive histopathological examination should be made by pathologists to ensure squamous differentiation and exclude all other differentials 4,6,9,10 .…”

“…A chemotherapy regimen of methotrexate, cisplatin, and bleomycin may be used, but still no effectiveness has been proven. The prognosis is poor, with a 5-year survival rate of less than10% 9,10 .…”