Squamous cell carcinoma of the renal pelvis presenting as an integumentary neoplasm of the flank

Abstract

Rationale:Although chronic pyelonephritis and urolithiasis are established risk factors for squamous cell carcinoma (SCC), only a minority of patients with chronic urolithiasis eventually develop SCC. It is believed that the chronic irritation leads to squamous cell metaplasia that may subsequently develop into SCC. Although studies show that SSC generally spreads locally with associated symptoms of lymphadenopathy, metastasis to the lungs and liver have also been reported. However, cases spreading to the flank have yet to be reported. Therefore, the use of reconstructive techniques for the repair of extensive soft tissue defects in the flank region after extended retroperitoneal resection, is unknown.Patient concerns:We report a 54-year-old man who presented with a 1-month history of an enlarged skin mass on the right flank.Diagnoses:The patient was subsequently diagnosed with metastatic SCC involving the patient's integumentary system near the flank region proximal to the right kidney following percutaneous nephrostomy.Interventions:The skin mass and the surrounding muscle tissue of the right flank were excised with a wide resection margin including radial nephrectomy. The soft tissue defect after resection was reconstructed using a unilateral gluteus maximus myocutaneous V-Y advancement flap.Outcomes:No recurrence of the SSC was found on follow-up CT performed 12 months postoperatively.Lessons:In patients with long-standing nephrolithiasis complicated by staghorn stone-related infections, biopsies from suspicious lesions detected during percutaneous nephrolithotomy may facilitate early diagnosis. The modified gluteus maximus V-Y advancement flap may be a useful technique for the reconstruction of extensive soft-tissue defects involving the flank region.

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

“…In our patient, the sinus tract between the previous PCNL site and the superior pole of the right kidney was formed. A similar finding was also observed in other reports [ 9 ]. Recurrent PCNL may be a risk factor for squamous metaplasia and subsequent SCC in the kidney with chronic pyelonephritis or nephrolithiasis.…”

“…A fistula between the lumbar skin and the pole of the kidney as presented in this case report has been reported less often. To the best of our knowledge, this is only the third such report in the literature [ 9 , 10 ]. In our patient, the sinus tract between the previous PCNL site and the superior pole of the right kidney was formed.…”

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

“…Histological examination of the skin mass showed an invasive well-differentiated squamous cell carcinoma. The PCNL had spread to surrounding tissues via the percutaneous nephrostomy track [5]. To our knowledge, there are only two similar reports (3 cases) in which RPCa appears to have been disseminated by PCNL (Table 1).…”

Primary squamous cell carcinoma of the renal pelvis presenting with severe hydronephrosis: A rare case report

“…Furthermore, paraneoplastic syndromes such as hypercalcemia, leukocytosis, and thrombocytosis may be associated with RSCC [ 3 ]. The main differential diagnosis of renal SCC is XGP (xanthogranulomatous), a structure also associated with renal calculi that leads to hydronephrosis and forms an inflammatory mass that destroy renal parenchyma, mimicking malignancy in addition to primary and secondary renal neoplasms [ 14 , 15 ]. It is highly possible that by the time of diagnosis, the tumor has invaded the renal parenchyma or adjacent tissues, and owing to its aggressive behavior, SCC often presents at stage-pT3 or higher and may spread to regional lymph nodes, lungs, and the liver, and rarely to bones [ 3 ].…”