Incidental squamous cell carcinoma of renal pelvis presenting as skin invasion: a case report

Abstract

Introduction Squamous cell carcinoma of the renal pelvis is a rare neoplasm, accounting for less than 0.8% of malignant renal tumors. Chronic irritation is believed to be the primary pathogenic cause for squamous cell carcinoma of the renal pelvis. The most frequently reported cases of squamous cell carcinoma of the renal pelvis generally present with hydronephrosis, pyelonephritis, or nephrolithiasis. The skin of the flank is a very uncommon site of clinical presentation. Here, we report an exceedingly rare case of squamous cell carcinoma of the renal pelvis presenting as skin invasion of the flank. Case presentation A 66-year-old Han Chinese man consulted our hospital because of a right lumbar skin lesion lasting more than 3 months. His physical examination revealed that he had a palpable mass about 6.0 cm × 5.0 cm in size at the posterior axillary line in the right low back with skin ulceration 3 mm in diameter and exudation on it. Magnetic resonance imaging showed hydronephrosis of the right kidney and plaque-like abnormal signal in the middle portion of the kidney. The patient underwent a right nephrectomy. The sinus tract formation between the ulcerative skin in the right low back and the middle portion of the right kidney could be found. The distended kidney could not be excised entirely for tight adhesion. Pathological examination showed moderately differentiated renal squamous cell carcinoma with invasion of the renal parenchyma and perirenal adipose tissue. Conclusion It is extremely rare for renal squamous cell carcinoma to present as skin invasion. Recurrent percutaneous nephrolithotomy may be a risk factor for squamous cell carcinoma of the renal pelvis. The possibility of renal squamous cell carcinoma should be kept in mind in patients who have hydronephrosis, nephrolithiasis, or chronic pyelonephritis for a long time or with renal anomalies. More radiological examinations are suggested for such patients.

Squamous cell carcinoma of the kidney in an End Stage Renal disease patient in a tertiary health care center; a case report and review of literature, Assiut university hospital experience 2021,

“…(5,8) The clinical presentation of the disease includes no characteristic symptoms and signs, making it very di cult to diagnose as in this case the diagnosis was di cult, all the signs were making the diagnosis directed toward infection or retro-peritoneal abscess also the CT guided biopsy was not conclusive, until exploration was done. (9) Pain, hematuria, local swelling of the loin and a stula formation or skin sinus as in our patient are symptoms that may occur in advanced disease (5,7,10) . The treatment is radical surgery, due to the rarity of the cases the conclusive decision of applying radiotherapy or chemotherapy either in advanced or early cases, preoperatively or postoperatively, can't be taken.…”

“…(3,4) Squamous cell carcinoma in ESRD is mentioned in the literature very few, There is no de nite cause to blame, but smoking, recurrent operation as PCNL, chronic irritation caused by stones or infection and squamous metaplasia are risk factors. (5)(6)(7) The most common cause is stones leading to squamous metaplasia, which was found in the previous kidney specimen that was removed from the patient two years ago. Squamous metaplasia considered by some authors as precancerous lesion, occurs more in the lower tract unlike the upper tract, and requires strict follow up .…”

Cutaneous fistula, a rare presentation of squamous cell carcinoma of the renal pelvis

“…The clinical presentation of the disease includes no characteristic symptoms and signs, making it very di cult to diagnose as in this case the diagnosis was di cult, all the signs were making the diagnosis directed toward infection or retro-peritoneal abscess also the CT guided biopsy was not conclusive, until exploration was done (9). Pain, hematuria, local swelling of the loin and stula formation or skin sinus as in our patient are symptoms that may occur in advanced disease (5,7,10). The treatment is radical surgery, due to the rarity of the cases the conclusive decision of applying radiotherapy or chemotherapy either in advanced or early cases, preoperatively or postoperatively, can't be taken (10)(11)(12) .To achieve similar outcome as transitional cell carcinoma the diagnosis must be early, as the main problem with this variant is its delayed diagnosis either according to the clinical picture or to radiological imaging (13).…”

“…Squamous cell carcinoma of the renal pelvis is a very rare variant, its incidence range from less than1 percent to less than 5-10 percent of all the upper urothelial tract tumors (3,4). Squamous cell carcinoma in ESRD is mentioned in the literature very few, There is no de nite cause to blame, but smoking, recurrent operation as PCNL, chronic irritation caused by stones or infection and squamous metaplasia are risk factors (5)(6)(7) .The most common cause is stones leading to squamous metaplasia, which was found in the previous kidney specimen that was removed from the patient two years ago. Squamous metaplasia considered by some authors as precancerous lesion, occurs more in the lower tract unlike the upper tract, and requires strict follow up (5,8).…”

Pelvicalyceal Squamous Cell Carcinoma: Incidental Diagnosis With Liver Metastasis on Follow Up

“…Chronic pyelonephritis, vitamin A deficiency, smoking, and several endogenous/exogenous chemicals being a few of them [4]. It has been postulated that the presence of longstanding nephrolithiasis initiates squamous metaplasia of urothelium due to chronic irritation which further develops into SCC [5]. This patient also had a long-standing history of the presence of stones which ultimately led to a nonfunctioning kidney for which nephrectomy was performed.…”