Squamous Cell Carcinoma of the Renal Pelvis Presented as Post-Obstruction Pyonephrosis: A Commonly Known Malignancy in a Rare Location

Sameer A Munshi, Hesham Saada, Shafaq Mujtaba and Mohamed A Elkoushy

Department of Specialized Surgery, Division of Urology, King Abdullah Medical City, Makkah, KSA
Department of Pathology, King Abdullah Medical City, Makkah, KSA
Department of Urology, Suez canal University, Ismailia, Egypt

^*Correspondance to: Mohamed A Elkoushy 

 PDF  Full Text DOI: 10.25107/2474-1647.2297

Abstract

Squamous Cell Carcinoma (SCC) of the renal pelvis is an extremely rare clinical entity, constituting less than 1% of all urinary tract neoplasms. The diagnosis is usually not possible due to inconclusive clinical and radiological features. Chronic urothelial irritation due to recurrent infection and longstanding nephrolithiasis would encourage squamous metaplasia of the renal collecting system and predispose to such aggressive nature of the tumor. A typical manifestations and consequent delay in diagnosis may result in locally advanced or metastatic disease upon presentation and poor prognosis and outcomes. We report a case of incidentally diagnosed squamous cell carcinoma of the renal pelvis in a 47-year-old man, presented with asymptomatic bilateral renal stones. Postright percutaneous nephrolithotomy, the patient developed severe intermittent left hypochondrial pain with spikes of fever with rigidity extending from below the left costal margin to the groin and crossing the middle line. Urethral catheter drained pure pus while the right nephrostomy tube drained clear urine. Left nephrectomy performed with intra operative drainage of ~2200 cc of pus from such a huge kidney containing multiple variable sized impacted calculi. Histopathology revealed moderately differentiated T4NxMx squamous cell arising from the renal pelvis. The case highlights the importance of careful gross and histopathological assessment of any specimen when associated with hydro or pyonephrosis secondary to a long-standing history of nephrolithiasis and an associated poor or non-functioning kidney. In the current report, a case will be presented with its clinical and morphological features together with a review of the relevant current literature.

Keywords

Squamous cell carcinoma; Kidney; Renal pelvis; Calculi; Pyonephrosis

Cite the article

Munshi SA, Saada H, Mujtaba S, Elkoushy MA. Squamous Cell Carcinoma of the Renal Pelvis Presented as Post-Obstruction Pyonephrosis: A Commonly Known Malignancy in a Rare Location. Clin Surg. 2019; 4: 2297.