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Renal Pelvis Squamous Cell Carcinoma

Epidermoid Cancer of the Kidney Pelvis


Presentation

  • The rarity of this metastatic tumour, with its unusual presentation, is discussed.[casereports.bmj.com]
  • Case presentation A 72 year-old female presented to the ED with 4 weeks of gradually worsening left upper and lower quadrant pain.[ncbi.nlm.nih.gov]
  • Most SCC of the renal pelvis present with advanced disease and dismal prognosis while our patient presented with localized disease without lymphatic and distant metastasis.[jcdr.net]
  • Squamous cell carcinoma of the renal pelvis presenting as hydronephrosis. J Can Res Ther 2010;6:537-9 Introduction Squamous cell carcinoma (SCC) of the renal pelvis is a rare tumor.[cancerjournal.net]
Abrupt Onset of Symptoms
  • The tumor generally presents with abrupt onset, severe symptoms and high serum calcium concentration of 14 mg/dl. The prognosis is very poor and associated with an advanced stage of malignancy [ 4 ].[karger.com]
Pallor
  • She had no fever and mild pallor. Two lymph nodes, 0.7 and 1 cm in diameter, were palpated in the left supraclavicular area. She had nonpitting edema on both legs that was more pronounced on the right leg with the presence of Homan's sign.[karger.com]
Pleural Effusion
  • There was minimal right pleural effusion on chest X-ray, with no abnormal pulmonary nodules. In searching for the primary site of malignancy, a left supraclavicular lymph node biopsy was performed.[karger.com]
  • X-ray Chest (postero-anterior view) depicted right pleural effusion. Trucut biopsy of the mass confirmed it as moderately differentiated SCC (cT4N2M1). In view of the grave prognosis, the patient and his relatives were psychologically counseled.[omicsonline.org]
  • These may include development of ascites, intestinal obstruction, deep vein thrombosis, malnutrition and cachexia, lymphedema, and pleural effusion. Current five-year survival rates for ovarian cancer are about 30% to 40%.[medical-dictionary.thefreedictionary.com]
Aspiration
  • Fine needle aspiration cytology (FNAC) from that lymph node mass was inconclusive. Figure 1: CECT scan depicting enhancing left renal mass with hydronephrosis and para-aortic lymph nodes.[omicsonline.org]
  • For a running feeding tube: Every 4-8 hours, it should be aspirated in order to monitor the gastric emptying. This applies especially to immobile and weak patients.[oncolex.org]
Constipation
  • For 2 months prior to admission, she had had intermittent right upper abdominal pain, vomiting, constipation, anorexia and significant weight loss.[karger.com]
  • The most common ( 20%) adverse reactions are diarrhea, hypertension, fatigue, decreased appetite, nausea, dysphonia, palmar-plantar erythrodysesthesia (hand-foot) syndrome, weight decreased, vomiting, asthenia, and constipation.[pfizer.com]
  • Elimination is maintained by administering stool softeners as necessary if analgesic drugs result in constipation.[medical-dictionary.thefreedictionary.com]
  • Other factors that can aggravate or prolong the presence of nausea and vomiting are: pain, anxiety, electrolyte disturbances, constipation, dyspepsia, and ulcers.[oncolex.org]
Upper Abdominal Pain
  • For 2 months prior to admission, she had had intermittent right upper abdominal pain, vomiting, constipation, anorexia and significant weight loss.[karger.com]
Abdominal Tenderness
  • There was abdominal tenderness in the left flank area with no palpable mass. Investigations revealed normal CBC, coagulation, renal functions, electrolytes, bone profile LFT, and chest X-ray. HIV 1 and 2 were negative.[urotoday.com]
Homans' Sign
  • She had nonpitting edema on both legs that was more pronounced on the right leg with the presence of Homan's sign. Deep vein thrombosis was suspected.[karger.com]
Hyperkeratosis
  • It is often referred to by several different names, including cholesteatoma, leukoplakia, and hyperkeratosis [1].[urotoday.com]
  • Gobello syndrome – reported in one individual in 2000, Gobello syndrome was associated with an organoid nevus with a velvety surface as well as excessive hairiness (hypertrichosis) and rough, elevated papules (follicular hyperkeratosis).[rarediseases.org]
Impulsivity
  • New impulses in oncologic therapy have occurred in surgery, radiation therapy, and tumor emboliza tion. A further important topic is renal tumors in infants.[books.google.com]
Confusion
  • The non-specific clinical and radiologic features in renal SCC may cause diagnostic confusion and histopathology is needed for confirmation.[ 2 , 3 , 4 , 9 ] Raghavendran et al .,[ 10 ] reported a case series of stones associated renal pelvic malignancies[ncbi.nlm.nih.gov]
  • The non-specific clinical and radiologic features in renal SCC may cause diagnostic confusion and histopathology is needed for confirmation.[2-4,9] 4 Jk Figure 2: Cut sections of the nephrectomy specimen (a and b) after the right radical nephroureterectomy[cyberleninka.org]
Neglect
  • Abstract Squamous cell carcinoma of the renal pelvis is a rare tumour, mainly occurring in elderly patients with neglected and secondarily infected pyelocaliceal stones. It has a poor prognosis.[ncbi.nlm.nih.gov]
  • In a study by Shah et al ( 19 ), the authors reported 2 cases of untreated/neglected renal stones and suggest the stones to be the cause of malignancy.[spandidos-publications.com]
  • Recurrent low-grade superficial bladder cancer is rarely life-threatening unless it is neglected such as if a patient does not bring recurrent symptoms or problems to the doctor's attention and it becomes invasive bladder cancer.[emedicinehealth.com]
Lethargy
  • The patients may present for the first time with anorexia, weight loss and/or lethargy, particularly in advanced cases ( Blacher et al., 1985 ; Gahagan and Reed, 1949 ; Booth et al., 1980 ).[omicsonline.org]
Hematuria
  • He had no history of hematuria, pyuria, or prior surgery.[ncbi.nlm.nih.gov]
  • He had no history of hematuria, pyuria, or prior surgery. Access this article online Quick Response Code: Website: www.clinicalimagingscience.org DOI: 10.4103/2156-7514.109741 Copyright: 2013 Kalayci OT.[cyberleninka.org]
Renal Impairment
  • The patient had extensive medical co-morbidities including chronic renal impairment, ischaemic heart disease with unstable angina, aortic stenosis and mitral regurgitation in addition to a previous cerebrovascular event (CVA) 8 years prior with residual[f1000research.com]

Workup

  • After proper workup, large calculus with heterogeneous density mass detected in nonfunctioning left kidney. After radical nephrectomy, histopathological examination revealed squamous cell carcinoma of renal pelvis.[ncbi.nlm.nih.gov]
  • Sudden onset of similar diffuse cutaneous lesions should elicit serious consideration for paraneoplastic disease and further workup to evaluate for an underlying cancer.[austinpublishinggroup.com]
  • Recent workup demonstrated a complex 6.5 cm mass arising from the lower pole of her atrophic left kidney.[ijpmonline.org]
  • SCC may be associated with paraneoplastic syndrome; [10] however, the laboratory workup of our patients did not show any abnormal results.[urologyannals.com]
  • Authors’ contributions All the authors contributed to the workup of the patient including clinical evaluation, investigation, and treatment planning. The manuscript has been reviewed and approved by all the authors.[jmedicalcasereports.biomedcentral.com]
Right Pleural Effusion
  • There was minimal right pleural effusion on chest X-ray, with no abnormal pulmonary nodules. In searching for the primary site of malignancy, a left supraclavicular lymph node biopsy was performed.[karger.com]
  • X-ray Chest (postero-anterior view) depicted right pleural effusion. Trucut biopsy of the mass confirmed it as moderately differentiated SCC (cT4N2M1). In view of the grave prognosis, the patient and his relatives were psychologically counseled.[omicsonline.org]
Pleural Effusion on Chest X-Ray
  • There was minimal right pleural effusion on chest X-ray, with no abnormal pulmonary nodules. In searching for the primary site of malignancy, a left supraclavicular lymph node biopsy was performed.[karger.com]
Pyuria
  • He had no history of hematuria, pyuria, or prior surgery.[ncbi.nlm.nih.gov]
  • He had no history of hematuria, pyuria, or prior surgery. Access this article online Quick Response Code: Website: www.clinicalimagingscience.org DOI: 10.4103/2156-7514.109741 Copyright: 2013 Kalayci OT.[cyberleninka.org]
Dyslipidemia
  • Her medical conditions were hypertension and dyslipidemia, and she was receiving treatment with amlodipine and simvastatin. She was a passive smoker and did not drink alcohol. There was no history of malignancy in her family.[karger.com]
Thrombocytosis
  • Paraneoplastic syndromes such has hypercalcemia, leukocytosis, and thrombocytosis have been observed.[ncbi.nlm.nih.gov]
  • Laboratory tests revealed a leucocytosis (WBC 38000/mm3 with 90% neutrophils, absence of abnormal or immature cells), grade IV anemia (normocytic, normochromic with a hemoglobin of 6.8 g/dL), thrombocytosis (platelet count of 585000/mm 3 ).[imedpub.com]
Creatinine Decreased
  • The most common ( 20%) lab abnormalities occurring in patients receiving INLYTA (all grades, vs sorafenib) included increased creatinine, decreased bicarbonate, hypocalcemia, decreased hemoglobin, decreased lymphocytes (absolute), increased ALP, hyperglycemia[pfizer.com]
Pleural Effusion
  • There was minimal right pleural effusion on chest X-ray, with no abnormal pulmonary nodules. In searching for the primary site of malignancy, a left supraclavicular lymph node biopsy was performed.[karger.com]
  • X-ray Chest (postero-anterior view) depicted right pleural effusion. Trucut biopsy of the mass confirmed it as moderately differentiated SCC (cT4N2M1). In view of the grave prognosis, the patient and his relatives were psychologically counseled.[omicsonline.org]
  • These may include development of ascites, intestinal obstruction, deep vein thrombosis, malnutrition and cachexia, lymphedema, and pleural effusion. Current five-year survival rates for ovarian cancer are about 30% to 40%.[medical-dictionary.thefreedictionary.com]

Treatment

  • There are still no standard treatments for SCC of the renal pelvis. Some literature suggests the primary treatment of renal pelvic SCC is nephrectomy.[tro.amegroups.com]
  • New treatment modalities are urgently needed to improve the poor prognosis in patients with advanced stage squamous cell carcinoma and urothelial carcinoma of the upper urinary tract.[nebraska.pure.elsevier.com]
  • Radical surgical resection is the foremost treatment option, as alternative treatments are of limited efficacy.[ncbi.nlm.nih.gov]
  • The insidious onset of symptoms and the lack of any pathognomic sign lead to a delay in diagnosis and treatment. Squamous cell carcinoma is frequently associated with urolithiasis and hydronephrosis [2,3,4].[urotoday.com]
  • Therefore, most patients should require treatment of staghorn stones. The treatment options are medical therapy, surgery, percutaneous nephrolithotomy and shock wave lithotripsy.[karger.com]

Prognosis

  • Conclusions: The prognosis for squamous cell carcinoma is poor, but stage for stage the prognosis is not different between patients with urothelial carcinoma and squamous cell carcinoma of the renal pelvis and ureter.[nebraska.pure.elsevier.com]
  • It has a poor prognosis. The authors report the case of a 74-year old man with a destroyed and painful kidney containing a staghorn calculus for 30 years.[ncbi.nlm.nih.gov]
  • Abstract Squamous cell carcinoma (SCC) of the renal pelvis is a rare cancer with a extremely poor prognosis. Its incidence is only 0.5–1% of all urothelial cancers.[tro.amegroups.com]
  • Most SCC of the renal pelvis present with advanced disease and dismal prognosis while our patient presented with localized disease without lymphatic and distant metastasis.[jcdr.net]

Etiology

  • In our case, chronic irritation and superadded fungal infection is most likely the etiology of this rare carcinoma of the renal pelvis. Ureteral obstruction is the main cause of presenting symptoms.[urotoday.com]
  • Different etiological factors including renal calculi, hydronephrosis, chemical use/abuse, vitamin A deficiency, and hormonal imbalances have been implicated in the pathogenesis of upper tract SCC. 5 The strongest association has been reported with stone[ncbi.nlm.nih.gov]
  • […] squamous differentiation Epidemiology Very rare tumor, except for patients with nonfunctioning hydronephrotic kidney due to renal pelvic stone disease ( Mol Clin Oncol 2015;3:941 ) Approximately equal men and women, age 50 - 70 years ( J Urol 2007;178:51 ) Etiology[pathologyoutlines.com]
  • Various etiological features have been held responsible for squamous metaplasia and subsequent carcinoma. Of these, renal calculi and infection are the leading ones.[ccij-online.org]

Epidemiology

  • […] urothelial differentiation (invasive or in situ) and not combined with another renal neoplasm Terminology Cases with associated urothelial carcinoma or urothelial carcinoma in situ are best classified as urothelial carcinoma with squamous differentiation Epidemiology[pathologyoutlines.com]
  • The issue of synergistic effects can be appropriately addressed by epidemiological studies that show stratified analysis and have sufficient power.[greenfacts.org]
  • Bladder Cancer Epidemiology Bladder cancer is the fourth-most common cancer in the United States, 1 affecting men 3 times more than women. 1 In 2014, 74,690 new cases and 15,580 deaths are projected to occur in the United States. 2 This represents 4.5%[onclive.com]
  • "The Epidemiology of Renal Cell Carcinoma". Journal of Urology. 176 (6): 2353–235. doi : 10.1016/j.juro.2006.07.130. PMID 17085101. Retrieved 2012-07-15. Thyavihally YB, Tongaonkar HB, Desai SB (September 2005).[en.wikipedia.org]
  • Epidemiology of transitional cell carcinomas of the renal pelvis is similar to those of the rest of the urinary tract: please refer to TCCs of urinary tract for further details.[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • References Healy KA, Ogan K: Pathophysiology and management of infectious staghorn calculi. Urol Clin North Am 2007;34:363-374.[karger.com]
  • Other risk factors include race, age, sex, bladder birth defects, genetics, long-term chemotherapy with cyclophosphamide, pelvic radiation, and having taken pioglitazone for diabetes for more than 1 year. 3 Pathophysiology Non–muscle invasive disease[onclive.com]
  • Pathophysiology TCC accounts for more than 90% of renal pelvic tumors; other cancer types seen include squamous cell carcinoma (SCC) and adenocarcinoma.[emedicine.medscape.com]

Prevention

  • Treatment is essentially preventive by removal of staghorn calculi and management of chronic urinary tract infections.[ncbi.nlm.nih.gov]
  • This emphasizes the need of early treatment of nephrolithiasis to prevent the development of SCC and screening of patients with long standing staghorn calculi.[jcdr.net]
  • Removal of the staghorn stone is necessary to eliminate infection and prevent squamous metaplasia of the renal epithelium.[karger.com]
  • Neoadjuvant chemotherapy prior to nephroureterectomy is recommended for high grade and high stage lesions because other treatments can decrease renal function, often preventing subsequent use of adjuvant chemotherapy.[merckmanuals.com]

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