YO3 - Squamous cell carcinoma of renal parenchyma in a 30 year old female with renal calculi

Case summary

Primary squamous cell carcinoma (SCC) of renal parenchyma is a rare neoplasm. The diagnosis is usually unsuspected due to rarity and inconclusive clinical and radiological features. The condition is also associated with advanced stage at diagnosis and a poor prognosis. Different etiological factors have been implicated in the pathogenesis of upper tract SCC including renal calculi, hydronephrosis, chemical use/abuse, vitamin A deficiency, and hormonal imbalances. We report a case of a 30-year-old female with history of long-standing suspicion of renal calculi. Subsequently, it progressed into a right non-functioning kidney and right pyelonephritis. She underwent a right nephrectomy which was complicated with iatrogenic ascending colon injury warranting a right hemicolectomy. Histopathological examination of the right kidney specimen revealed acute on chronic pyelonephritis and right hemicolectomy specimen revealed perforation with surrounding inflammation. Her postoperative period was eventful. She suffered from persistent pus drainage, intra-abdominal collection and possible fistulation between second part of duodenum and right renal fossa collection. She underwent further surgical intervention with duodenal segmental resection and gastrojejunostomy. Histopathological examination from the latter surgery revealed squamous cell carcinoma. In view of the diagnosis, it prompted a second look into the initial nephrectomy specimen which revealed a foci of squamous metaplasia. The mainstay of treatment in SCC of renal parenchyma is radical surgical resection. Chemotherapy has been shown to be of modest benefit and often reserved in metastatic cases. Despite aggressive surgical intervention, prognosis remains poor. The suspicion of SCC should be acknowledged in in a patient with long history of renal calculi to prompt early diagnosis and definitive treatment.

Keywords: renal mass, kidney, renal pelvis squamous cell carcinoma

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