An unusually early, rare complication of Nephrolithiasis: Sq
Jacob Punnooran
An unusually early, rare complication of Nephrolithiasis: Squamous cell carcinoma of renal pelvis.
Introduction:

Squamous cell carcinoma of renal pelvis is an aggressive, rare neoplasm associated with long standing renal stone disease, and poor prognosis.

Description of the problem:

62 year old man presented to surgical OPD in 2010 with left sided flank pain, fever and vomiting. Renal stones detected on cystoscopy; removed by percutaneous nephrolithotomy. Urethroscopy in 2013 for similar complaints. In 2015 he developed renal colic and nephrolithiasis and underwent retrograde pyelogram and DJ stenting. CT Urogram revealed enlarged left kidney with heterogeneous mass with nodular calcification. CT guided FNAC suggestive of malignant neoplasm with squamous differentiation; he underwent left radical nephrectomy. Post-operative HPE confirms moderately differentiated squamous cell carcinoma (pT4N+MO) infiltrating psoas muscle. Further investigations revealed increased tracer uptake in right shoulder joint, liver metastasis and suspicious bibasal lung nodule. Patient received chemo and radiation therapy and currently admitted for palliative care.

Differential diagnosis:

CT scan suggests possibility of renal cell carcinoma, transitional cell carcinoma or squamous cell carcinoma of renal pelvis.

Discussion:

Arising following chronic irritation, followed by squamous metaplasia and dysplasia, primary SCC of renal pelvis is rare, representing 0.5-0.8% of malignant renal tumours. Mostly associated with long standing nephrolithiasis, it should be suspected in such cases with recurrent, frequent urinary symptoms.

Conclusion:

Squamous cell carcinoma of renal pelvis are rare tumours with strong association with nephrolithiasis. CT and MRI are pointers to diagnosis, histopathology being the gold standard.

Implication for clinical practice:

A history of renal calculi should make the clinician investigate for early markers of this rare and highly malignant tumour
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