Then, the patient was referred to the urology team for surgical
resection. The patient underwent left radical open nephrectomy with lymph node dissection. The pathology specimen was sent to the pathology department for further assessment. Histopathologic examination of the specimen revealed invasive squamous cell carcinoma (SCC) originating from the renal pelvis and extensively infiltrating the renal parenchyma. There is also marked inflammation, which seen in the vicinity of the infiltrating neoplasm and number of CD68-positive cells. The final diagnosis was made to be renal DAPT datasheet SCC coexistence with xanthogranulomatous pyelonephrits in one kidney with multiple liver and bone metastasis. XGP is an uncommon form of chronic pyelonephritis that occurs as a result of chronic obstruction and subsequent infection. Almost all cases of XGP (90%) are associated with renal calculi. CT is the imaging modality of choice for XGP, as it provides an accurate estimate of the extent of the disease, thus helping in surgical planning. Diagnosis of XGP is usually made by the presence of an enlarged nonfunctioning kidney with large obstructing staghorn calculus, caliceal dilatation, low attenuation areas replacing the renal parenchyma secondary to inflammatory infiltrate,
and perinephric stranding.1 All the aforementioned features were present on the CT images of our patient, and therefore XGP was the leading consideration. Selleckchem BMS 354825 Primary renal squamous cell carcinoma is a rare cancer with a variable incidence of
approximately 0.5%-15% of all urothelial cancers.1, 2, 3 and 4 There are only isolated case reports and scant case series of such cases in the English literature. SCC of the renal pelvis is the second most common malignancy after adenocarcinoma. The etiologic factors which play in the genesis of this rare malignancy are strongly associated with phenacetin consumption, chronic renal calculi, pyelonephritis, and squamous metaplasia.3 The kidney is usually nonfunctional because of chronic obstruction. SCC presents as a renal pelvic infiltrative lesion without evidence of a distinct mass. Diagnosis of renal SCC is difficult as characteristic features usually not associated with renal SCC, added by imaging techniques which reveals only calculi and hydronephrosis.1 and 3 Therefore, initial diagnosis whatever of SCC is mostly based on histologic analysis as was seen in the present case.4 Lee et al5 in their study classified these tumors into 2 groups, according to localization of the tumors as central and peripheral. Central renal cell carcinoma presents more intraluminal components and is usually associated with lymph node metastasis, whereas peripheral renal SCC presents with prominent renal parenchymal thickening and might invade the perirenal fat tissue before lymph node or distant metastasis could be identified. XGP is a risk factor for malignancy because of chronic irritation by the presence of stones and associated chronic infection.