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  Table of Contents    
CASE REPORT  
Year : 2012  |  Volume : 55  |  Issue : 3  |  Page : 370-371
Primary squamous cell carcinoma of the renal parenchyma


1 Department of Surgical Oncology, Army Hospital (Research and Referral), Delhi, India
2 Department of Pathology, Army Hospital (Research and Referral), Delhi, India

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Date of Web Publication29-Sep-2012
 

   Abstract 

No case of a primary renal parenchymal squamous cell carcinoma (SCC) has been reported previously in the literature although renal pelvic SCCs are well known. We report an unusual case in a 60-year-old lady who presented with significant weight loss. She was found to have a mid and lower pole left renal tumor with enlarged para-aortic nodes. A left radical nephrectomy and nodal dissection was performed and the pathological stage was T4N1M0. No adjuvant therapy was given. She is alive at 13 months post-surgery.

Keywords: Advanced, parenchyma, renal, squamous

How to cite this article:
Kulshreshtha P, Kannan N, Bhardwaj R, Batra S. Primary squamous cell carcinoma of the renal parenchyma. Indian J Pathol Microbiol 2012;55:370-1

How to cite this URL:
Kulshreshtha P, Kannan N, Bhardwaj R, Batra S. Primary squamous cell carcinoma of the renal parenchyma. Indian J Pathol Microbiol [serial online] 2012 [cited 2019 Jun 19];55:370-1. Available from: http://www.ijpmonline.org/text.asp?2012/55/3/370/101747



   Introduction Top


To the best of our knowledge, no case of a primary squamous cell carcinoma (SCC) of the renal parenchyma has been reported. SCC of the renal pelvis, however, is a known entity, the reported incidence being 1.4% of all renal malignancies. [1] Various etiological factors that have been implicated include renal calculi, infection, endogenous and exogenous chemicals, hormonal imbalance, and vitamin A deficiency, although tumors have been reported in the absence of these factors. [2] We report a case of primary renal parenchymal SCC in a 60-year-old lady.


   Case Report Top


A 60-year-old postmenopausal hypertensive lady presented with significant weight loss of 3 months duration. There was no fever, urinary complaints, or abdominal pain. Routine hematological, biochemical tests, and chest X-ray were normal. An abdominal ultrasound revealed a 6.5 5.5 4 cm mass lesion in the mid and lower third of the left kidney without associated hydronephrosis or calculi. Retroperitoneal lymph nodes (LN) were found to be enlarged. On contrast-enhanced computed tomography (CECT) scan, the mass was heterogeneously enhancing, with areas of necrosis [Figure 1]. It did not appear to infiltrate any adjacent organ. Retroperitoneal LN enlargement was noted in the left para-aortic and inter-aortocaval regions, with a maximum diameter of 2 cm. No distant metastases were found on CECT chest or bone scan.
Figure 1: CECT of the abdomen showing a heterogeneously enhancing mass in the mid and lower pole of left kidney. Areas of necrosis are notable

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She underwent a left radical nephrectomy with dissection of all enlarged LN stations. On gross examination, the tumor was confined to the mid and lower pole with a variegated appearance on cut section and no obvious infiltration of the pelvicalyceal system [Figure 2]. Final histopathology revealed pure Gr I keratinizing SCC of the renal parenchyma, infiltrating the Gerota's fascia. The nodes showed deposits of SCC (pT4N1). Of note, there was no urothelial component and the renal pelvis was normal [Figure 3]. This was confirmed by a relook thin sectioning of the renal pelvis to absolutely rule out a renal pelvic SCC with extensive parenchymal component. An 18-F Flouro deoxy-glucose-positron emission imaging FDG-PET/CT scan was done to rule out metastases from an unknown primary site. Epithelial growth factor receptor (EGFR) study was done to explore the possibility of adjuvant therapy. However, it turned out to be negative. She is alive and disease free at 13 months post-surgery.
Figure 2: Gross photograph of the nephrectomy specimen showing a cortical mass (blue arrow) at the mid and lower pole with variegated cut surface, including areas of hemorrhage, necrosis, and cystic change. The pelvicalyceal system (black arrow) appears separate

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Figure 3: Photomicrograph showing areas of squamous differentiation with keratin deposition. No urothelial component is visible (Hematoxylin and Eosin, ×40)

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   Discussion Top


SCC of the renal parenchyma has not been reported previously to the best of our knowledge. All reported SCCs in the kidney have been found to originate from the renal pelvis. Of all urothelial carcinomas, SCC constitutes only 0.7-7%. [3] Women are affected more frequently, the most common age group being 50-70 years. [2] SCC of the renal pelvis tends to be sessile, ulcerated, and infiltrative at diagnosis.

A significant urothelial component should be absent for the diagnosis of renal SCC. Such tumors should be classified as urothelial carcinoma with squamous differentiation. The squamous component here is not different from other SCCs and shows keratin pearls, intercellular bridges, and keratotic cellular debris. [4] For it to be called a renal parenchymal SCC, the renal pelvis should be histologically normal, as in our case.

SCC of the renal pelvis is thought to arise via squamous metaplasia of urothelium due to chronic irritation. [1] The genesis of renal parenchymal SCC is unknown, although a similar mechanism probably underlies. No apparent cause of chronic irritation, in the form of chemicals, drugs, vitamin deficiency, calculi, smoking, or schistosomiasis could be elicited in our case.

Stage by stage, they tend to have the same prognosis as urothelial cancers, although they tend to present at a more advanced stage. [5] This was the case in our patient.

Surgery has been the traditional mainstay of therapy for renal pelvic SCC, with adjuvant therapy only of marginal benefit. The possibility of anti-EGFR therapy in renal SCCs expressing the receptor needs further evaluation in a research setting. The same could not be used in our patient due to absence of EGFR expression. The patient is alive and disease free at 24 months post surgery.


   Conclusion Top


To conclude, SCC of the renal parenchyma is an extremely rare entity. The diagnosis should be made after carefully excluding an urothelial component and pelvic origin, even in the absence of known risk factors for SCC. The disease tends to present late as in our case, but aggressive surgery including lymph nodal dissection may have benefit in terms of local control and disease-free survival.

 
   References Top

1.Tyagi N, Sharma S, Tyagi SP, Maheshwari V, Nath P, Ashraf SM, et al. A histomorphologic and ultrastructural study of the malignant tumors of the renal pelvis. J Postgrad Med 1993;39:197-201.  Back to cited text no. 1
    
2.Talwar N, Dargan P, Arora MP, Sharma A, Sen AK. Primary squamous cell carcinoma of the renal pelvis masquerading as pyonephrosis: A case report. Indian J Pathol Microbiol 2006;49:418-20.  Back to cited text no. 2
    
3.Mizusawa H, Komiyama I, Ueno Y, Maejima T, Kato H. Squamous cell carcinoma in the renal pelvis of a horseshoe kidney. Int J Urol 2004;11:782-4.  Back to cited text no. 3
[PUBMED]    
4.Reuter VE. The urothelial tract: Renal pelvis, ureter, urinary bladder and urethra. In: Mills SE, Carter D, Greenson JK, Oberman HA, Reuter V, Stoler MH, editors. Sternberg's Diagnostic Surgical Pathology. 4 th ed. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 2058-9.  Back to cited text no. 4
    
5.Kose F, Bal N, Ozyilkan O. Squamous cell carcinoma of the renal pelvis. Med Oncol 2009;26:103-4.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
N Kannan
Department of Surgical Oncology, Army Hospital (R and R), Delhi Cantt, Delhi - 10
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.101747

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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Kulshreshtha, P., Kannan, N., Bhardwaj, R., Batra, S.
Indian Journal of Pathology and Microbiology. 2013; 56(1): 70
[Pubmed]
2 Comment on: Primary squamous cell carcinoma of the renal parenchyma
Pusiol, T., Zorzi, M.G., Morini, A.
Indian Journal of Pathology and Microbiology. 2013; 56(1): 70
[Pubmed]



 

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    Abstract
   Introduction
   Case Report
   Discussion
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    References
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