Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2010  |  Volume : 6  |  Issue : 4  |  Page : 537-539

Squamous cell carcinoma of the renal pelvis presenting as hydronephrosis

1 Department of Pathology, Medical College, Kolkata - 700 073, India
2 Department of Pathology, N R S Medical College, Kolkata - 700 014, India

Date of Web Publication24-Feb-2011

Correspondence Address:
Ranjana Bandyopadhyay
1B/3, Uttarpara Housing Estate, 88 B, G T Road, P.O.- Bhadrakali, Hooghly - 712 232, West Bengal
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.77060

Rights and Permissions
 > Abstract 

Primary malignant tumors of the renal pelvis are relatively rare with squamous cell carcinoma (SCC) accounting for 0.7% to 7%. We present a case of a 58-year-old male with huge hydronephrosis on the left side where histology of the resected specimen showed features of SCC. There was no evidence of renal calculi or other predisposing factors. The case highlights the rarity of the tumor in the absence of calculi, as well as the importance of a careful study of a gross specimen and histologic sections in every case of hydronephrosis.

Keywords: Hydronephrosis, renal pelvis, squamous cell carcinoma

How to cite this article:
Bandyopadhyay R, Biswas S, Nag D, Ghosh AK. Squamous cell carcinoma of the renal pelvis presenting as hydronephrosis. J Can Res Ther 2010;6:537-9

How to cite this URL:
Bandyopadhyay R, Biswas S, Nag D, Ghosh AK. Squamous cell carcinoma of the renal pelvis presenting as hydronephrosis. J Can Res Ther [serial online] 2010 [cited 2022 May 19];6:537-9. Available from: https://www.cancerjournal.net/text.asp?2010/6/4/537/77060

 > Introduction Top

Squamous cell carcinoma (SCC) of the renal pelvis is a rare tumor. The incidence of this tumor is 1.4% of all renal malignancies. [1] Different etiological factors including renal calculi, infection, endogenous and exogenous chemicals, vitamin A deficiency, and hormonal imbalance have been implicated in its pathogenesis. But tumors have been reported even in the absence of these factors. [2] We report a case of SCC of the renal pelvis presenting as hydronephrosis without any renal calculi. The tumor was diagnosed only after resection of the specimen.

 > Case Report Top

A male patient, weaver by occupation and aged 58 years, presented with complaints of heaviness and swelling of left upper abdomen for last 1 year. The swelling was gradual in onset and he had occasional burning sensation in urine. There was no history of fever or hematuria. He also experienced occasional pain in the left loin without any radiation and there was a history of generalized weakness for 3 months. Routine hematology, biochemical tests, and chest radiograph were normal. Urinalysis revealed microscopic hematuria. Ultrasonography (USG) of whole abdomen showed huge hydronephrosis of left kidney with floating echogenic patches inside the hydronephrotic sac suggestive of pyonephrosis. The left ureter was normal. The right kidney was normal in size, shape, and echotexture. Urinary bladder was empty. There was no ascites or lymphadenopathy. CT scan showed left gross hydrenephrosis with a markedly dilated cystic pelvicalyceal system filling the abdominal cavity [Figure 1]. There was no history of past radiation exposure or renal stones.
Figure 1: CECT of the abdomen showing gross hydrenephrosis of the left kidney with markedly dilated cystic pelvicalyceal system

Click here to view

On operation, a huge specimen of kidney measuring 30×20×15 cm was obtained. The whole mass was a distended sac-like structure without any grossly visible renal tissue. The cut surface showed multiple loculi with necrotic material within it. Some areas showed thickening of wall with an irregular inner surface [Figure 2]. Histology of the irregular areas in the hydronephrotic sac revealed features of moderately differentiated SCC [Figure 3]. The tumor invaded the muscle but did not penetrate it. There was no involvement of the retroperitoneal soft tissues. The entire tumor showed exclusive squamous differentiation. No transitional element was found within the tumor. The regional lymph nodes were not involved and there was no distant metastasis at presentation (Pathological stage T2N0M0).
Figure 2: Gross specimen of the hydronephrotic kidney with cut surface (inset) showing multiple loculi and thickening of wall with an irregular inner surface

Click here to view
Figure 3: Photomicrograph showing a high power view of moderately differentiated squamous cell carcinoma (H&E, ×400)

Click here to view

 > Discussion Top

Primary malignant tumors of the renal pelvis are relatively rare and constitute approximately 8% to 14% of all the renal malignancies. [1] Urothelial carcinoma occurs in more than 90% of such cases and SCC in only 0.7% to 7%. [3] Women are affected more frequently than men, predominantly in the age group of 50 to 70 years. [2] SCC of the renal pelvis tends to be sessile, ulcerated, and infiltrative at the time of diagnosis. The presence of necrotic material and keratin debris in the surface is a relatively constant feature.

The diagnosis of SCC of the renal pelvis is restricted to tumors showing extensive squamous differentiation. If a significant urothelial element including urothelial carcinoma in situ is found, the tumor should be classified as urothelial carcinoma with squamous differentiation. The histologic hallmarks of pearl formation, intercellular bridges, and keratotic cellular debris are those of squamous carcinoma at any site. With the exception of the verrucous variant, most of these carcinomas are moderately or poorly differentiated and more deeply invasive at the time of diagnosis than the majority of transitional cell carcinoma. [4]

SCC of the urothelial tract is thought to arise through a process of metaplasia of the urothelium. A large percentage of patients have squamous metaplasia of the adjacent urothelium. Various etiological features have been held responsible for squamous metaplasia and subsequent carcinoma. Of these, renal calculi and infection are the leading ones. Other factors implicated include exogenous and endogenous chemicals, vitamin A deficiency and hormonal imbalance, schistosomiasis, and smoking. [1] However cases have been reported in which no apparent etiological factor could be detected. [2] In our case also, no such etiological factor could be identified. In the absence of calculi or the significant mass effect of the tumor, the etiology of hydronephrosis was difficult to explain. As the hydronephrotic sac was filled with necrotic materials and as the tumor was mainly exophytic in nature, some sloughed tumor tissue might have obstructed the ureter and had caused hydronephrosis. Another possibility is the tumor has arisen in a chronically inflamed hydronephrotic sac. Hydronephrosis and even pyonephrosis with peritoneal abscess formation have been reported in upper urinary tract carcinomas. [5] Ng et al, have described hydronephrosis to be strongly related to the advanced pathologic stage, mostly with diseases extending beyond the kidney and those showing metastasis. [6] They have also noted that hydronephrosis is more common in renal tumors than the renal pelvic ones.

Surgery is the mainstay of therapy in SCC of renal pelvis and may result in cure in low stage patients. Systemic chemotherapy has only marginal benefit. The prognosis of SCC of the renal pelvis is very poor with a median survival of 3.5 months. Their generally poor prognosis can be attributed to the typically advanced stage at diagnosis, but stage for stage, prognosis is similar for squamous and usual urothelial carcinoma. [7] In the present case, the patient received three cycles of platinum-based chemotherapy. He attended the follow up clinic up to 6 months without any evidence of metastasis, after which he was lost to follow up.

To conclude, SCC of the renal pelvis may present as hydronephrosis and a careful search for any abnormal area in the wall should be attempted especially in the presence of necrotic materials in the cyst. A diagnosis of malignancy should be considered in cases of inflammatory pathology involving the renal pelvis, who has no known risk factor such as calculi or diabetes mellitus. [2] Careful history taking may give some clue for the presence of risk factors but SCC of the renal pelvis may occur in the absence of any of the predisposing conditions. Interestingly in the present case the disease was confined to the organs with no local spread or evidence of metastasis.

 > References Top

1.Tyagi N, Sharma S, Tyagi SP, Maheshwari V, Nath P, Asharf 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
[PUBMED]  Medknow Journal  
2.Talwar N, Dargan P, Arora MP, Sharma S, 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
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.Chung SD, Lai MK, Chueh SC, Wang SM, Yu HJ. An unusual cause of pyonephrosis and intra-peritoneal abscess: Ureteral urothelial carcinoma. Int J Infect Dis 2009;13:e39-40.  Back to cited text no. 5
6.Ng CK, Shariat SF, Lucas SM, Bagrodia A, Lotan Y, Scherr DS, et al. Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma? Urol Oncol 2008 Dec 29.   Back to cited text no. 6
7.Kose F, Bal N, Ozyilkan O. Squamous cell carcinoma of the renal pelvis. Med Oncol 2009;26:103-4.  Back to cited text no. 7


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Primary squamous cell carcinoma of the kidney parenchyma with ascending colon invasion: A case report and literature review
Cheol Kyu Oh, Joo Yeon Kim
International Journal of Surgery Case Reports. 2022; 91: 106762
[Pubmed] | [DOI]
2 Squamous cell carcinoma of the right renal pelvis in a 46-years-old with long history of right pyelolithiasis. A case report and review of literature
Makama Baje Salihu, Stephen Yusuf, Adogu Ibrahim Ogere
Annals of African Medical Research. 2021; 3(2)
[Pubmed] | [DOI]
3 Renal Squamous Cell Carcinoma due to Staghorn Kidney Stone-Case Report
Hossein Dialameh, Negar Behtash, Alimohammad Fakhr Yasseri, Farshad Namdari, Farzad Biglari, Mohammad Shirekhoda
Annals of Military and Health Sciences Research. 2021; 18(4)
[Pubmed] | [DOI]
4 Incidental squamous cell carcinoma of renal pelvis presenting as skin invasion: a case report
Xinghui Sun, Yongqing Li
Journal of Medical Case Reports. 2020; 14(1)
[Pubmed] | [DOI]
5 Primary renal squamous cell carcinoma mimicking the renal cyst: a case report and review of the recent literature
Peng Jiang, Chaojun Wang, Shanwen Chen, Jun Li, Jianjian Xiang, Liping Xie
BMC Urology. 2015; 15(1)
[Pubmed] | [DOI]
6 Atypical presentation of primary renal squamous cell cancer : a case report
Mrinal Pahwa,Archna Pahwa,Mohit Girotra,Arun Chawla
International Journal of Cancer Therapy and Oncology. 2014; 2(1): 02015
[Pubmed] | [DOI]
7 Renal Pelvis Squamous Cell Carcinoma With Inferior Vena Cava Infiltration: Case Report And Review Of The Literature
Z.M. Lin,J.K. Chng,T.T. Chong,K.C. Soo
International Journal of Surgery Case Reports. 2014;
[Pubmed] | [DOI]
8 Primary Intraparenchymal Squamous Cell Carcinoma of the Kidney: A Rare and Unique Entity
Prithwijit Ghosh,Kaushik Saha
Case Reports in Pathology. 2014; 2014: 1
[Pubmed] | [DOI]
9 Incidentally detected squamous cell carcinoma of renal pelvis in patients with staghorn calculi A case report and literature review
Jiun-Hung Geng,Yi-Ting Chen,Yung-Shun Juan,Chun-Hsiung Huang,Yii-Her Chou,Chii-Jye Wang,Wen-Jeng Wu,Shu-Pin Huang,Ching-Chia Li,Yung-Chin Lee,Chia-Chu Liu,Wan-Ting Huang,Chee-Yin Chai
Urological Science. 2013;
[Pubmed] | [DOI]
10 Squamous cell carcinoma of the renal pelvis
Bhaijee, F.
Annals of Diagnostic Pathology. 2012; 16(2): 124-127
11 Squamous cell carcinoma of the renal pelvis
Feriyl Bhaijee
Annals of Diagnostic Pathology. 2012; 16(2): 124
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case Report>Discussion>Article Figures
  In this article

 Article Access Statistics
    PDF Downloaded388    
    Comments [Add]    
    Cited by others 11    

Recommend this journal