Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature

Abstract

Case presentation In the current study, we report a 69-year-old female patient who was initially diagnosed with xanthogranulomatous pyelonephritis (XGPN) with nephrolithiasis and a peri-renal abscess. She presented to our department with right flank pain. Physical examination revealed right costovertebral angle knocking pain and computed tomography revealed dilated calyces and one staghorn stone over right kidney, with multiple abscess accumulations over the right peri-renal region. Right radical nephrectomy was performed using a transperitoneal flank approach, and pathology revealed squamous cell carcinoma (SCC) with concurrent XGPN. The patient was alive at 4 months post-operative follow-up. To the best of our knowledge, this is only the fifth case of renal SCC with concurrent XGPN reported in the English medical literature. Conclusion Renal SCC with coexisting XGPN is an extremely rare presentation and only four cases have been previously reported in the English medical literature. A positive diagnosis for this rare combination of diseases was established, based on pathological and immunohistochemical examinations after radical nephrectomy. Poor prognosis has been reported in such cases. Malignancies should be considered in patients with a long-standing history of urolithiasis.

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,

“…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) 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) .…”

“…(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

“…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).…”

“…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). 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).…”