Primary Squamous Cell Carcinoma Of Kidney -A Case Report And Review Of Literature

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International Journal of Life Sciences, Biotechnology and Pharma Research Vol. 12, No. 4, Oct-Dec 2023 Online ISSN: 2250-3137
Print ISSN: 2977-0122
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CASE REPORT
Primary Squamous Cell Carcinoma Of
Kidney - A Case Report And Review Of
Literature
Dr. Pardeep Garg1, Dr. Sheenu Priya2, Dr. Navik Goyal3
1Associate Professor and Head, 2,3Senior Resident, Dept. of Radiation Oncology, Guru Gobind Singh Medical
College and Hospital, Faridkot, India
Corresponding Author
Dr. Navik Goyal
Senior Resident, Dept. of Radiation Oncology, Guru Gobind Singh Medical College and Hospital, Faridkot,
India
Email: navikgoyal@gmail.com
Received: 07 December, 2023 Accepted: 30 December, 2023
ABSTRACT
Primary Squamous Cell Carcinoma (SCC) of the Kidney is a rare variety of Renal Cell Carcinoma. Patients present with
inconclusive signs and symptoms and thus diagnosis is unsuspected. Therefore, these patients land in advanced stage disease
and have poor prognosis. Here we present a Case of Squamous Cell Carcinoma Kidney, who presented in advanced stage,
his workup and the treatment done. A 52-year-old male presented with left flank pain and fever. A computerized tomography
(CT) scan showed nephrolithiasis and chronic inflammation in the left kidney and a soft tissue heterogenously enhancing
lesion at the upper pole causing hydronephrosis . He underwent Radical Nephrectomy and Histopathological examination
revealed an invasive, moderately differentiated squamous cell carcinoma involving renal parenchyma, perinephric tissue, fat
and hilar lymph nodes (stage 3). Thereafter, patient was treated with Radiotherapy and Chemotherapy ,then he was planned
for metronomic chemotherapy. Primary Renal squamous cell carcinomas are very rare tumours which are often not clinically
suspected or diagnosed. These tumours require thorough clinical examination, radiological workup, aggressive approach
towards treatment to add years in their life owing to worse prognosis and highly proliferative variety of the primary.
Keywords: Nephrolithiasis, Primary Renal squamous cell carcinoma, Radicalnephrectomy, Chemotherapy, Radiotherapy
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INTRODUCTION
Primary squamous cell carcinoma (SCC) of the
kidney is a rare occurrence, accounting for only 0.5–
7.0% of upper urinary tract tumors[1–5]. These tumors
are aggressive in nature with worse prognosis. As
SCC Kidney is rare as well as presentation is not like
common Renal tumors, diagnosis is delayed and this
adds to disease progression. This case discusses
Squamous cell carcinoma of the Kidney incidentally
diagnosed after nephrectomy for a chronically injured
kidney with nephrolithiasis and hydronephrosis.
CASE PRESENTATION
A 52-year-old male patient presented to the
Department of Oncology with a one-month history of
intermittent, localized, dull left flank pain, which
was associated with nausea, vomiting and fever. He
did not have macroscopic hematuria and had no other
urinary symptoms. On admission, physical
examination revealed left renal angle tenderness.
There was no abdominal distension, and there were no
palpable mass. Contrast enhanced CT scan showed
left kidney with calculi and a large heterogenously
enhancing lesion measuring 7*8 cm at the upper pole
causing hydronephrosis (figure 1). Careful imaging
study ruled out the presence of other systemic
involvement. Radical nephrectomy was performed
and histopathological examination revealed presence
of normal looking glomeruli and renal tubules along
with squamous carcinomatous component and keratin
pearls confirming diagnosis of SCC of kidney(figure
2). Renal capsule and perinephric adipose tissue and
hilar lymph nodes were involved with tumor (stage 3).
He was taken for Radiotherapy in view of localized
disease and given left flank radiation 40Gy /20#/4weeks
( Phase I ) and 16Gy /8#/2 weeks (Phase II) (Radiation
plan - figure 3).Thereafter, in view of persisting
residual disease and lymph nodal mets, he was given
6 Cycles of palliative systemic Chemotherapy -
Docetaxel (80mg/m2) and Carboplatin (AUC 6). He
was re- evaluated for disease status via PET-CT
Scan which showed disease progression with

International Journal of Life Sciences, Biotechnology and Pharma Research Vol. 12, No. 4, Oct-Dec 2023 Online ISSN: 2250-3137
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appearance of pulmonary metastasis. He was planned
for Metronomic Chemotherapy Geftinib 250 mg OD
and Capecitabine 1000 mg BD and his disease
remained stable for around 3 months. Few months
after, he developed breathlessness for which he was
on palliative treatment after which he died of
pulmonary failure. He remained alive for around 18
months post diagnosis .
Figure: 1-Computed tomography scan of the patient on presentation showing soft tissue lesion at upper
pole of the kidney causing significant hydronephrosis.
Figure: 2- Histopathological finding showing squamous cell carcinoma of the kidney.

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Figure: 3- Showing the radiation field taken for treatment of post op bed Normal kidney was shielded.
DISCUSSION
85–90% of Urinary tract cancers are urothelial /
transitional cell carcinomas, while pure squamous
cell carcinomas (SCC) are rare, accounting for only
0.5–7.0% of them and is known to arise from the
collecting system [1–7,9,18].
Patients present between the fifth to seventh decades
[1,4,5]. Some studies confirm that there is a female
predominance and the most common age group of
presentation is 50–70 years [8]. SCC of Kidney is
associated with renal stones, chronic infection and
infammation, which leads to squamous metaplasia,
dysplasia and eventually SCC [3-7,10,11]. SCC of the
Kidney is infrequently suspected or diagnosed
preoperatively due to its rarity and the non-specific
symptoms, signs and radiological findings [4,5, 8].
Histopathologically, squamous components in SCC of
kidney are similar to other SCCs and consist of
features of keratin pearls, intercellular bridges and
keratotic cellular debris. If the urothelial dysplastic
element is identifed along with urothelial carcinoma
in situ, the tumour should be classifed as primary
urothelial carcinoma with squamous differentiation.
Squamous metaplasia of urothelium with chronic
irritation is thought to cause SCC of the Kidney. [7,8,19]
Radiological fndings of renal pelvis SCC include a
solid renal pelvic or ureteric mass, hydronephrosis,
calcifcations or regional lymphadenopathy[4,7,8]. In our
case, Contrast enhanced CT scan of abdomen and
pelvis revealed a solitary renal mass without any
obvious other sites of lesion which could arise
possibility of renal metastasis. Also Solitary Renal
pathology was identified in the parenchyma sparing
the renal pelvis. Microscopically, primary renal SCC
resembles squamous cell carcinomas at other sites. In
the present case, the tumour was identifed in sections
of renal pelvis, adjacent perinephric tissue and hilar
lymph nodes. Extensive tumour necrosis is
documented in such cases with lymphovascular and
perineural invasion. Patients with renal SCC tend to
present at an advanced stage, usually at least T3 or
higher [1–4, 7]. The patient in the current case report
had stage III disease. Tumour recurrences have been
shown to typically develop rapidly, which was the case
in our patient [9,10]. The overall survival for patients
with SCC of the upper urinary tract is much worse in
comparison with patients with urothelial carcinoma
(UC) [1– 4,12,13,14] . However, when compared stage for
stage, there is no disease specifc 5- year survival
diference between SCC and UC [2,13]. There is
currently no standardized treatment protocol for
management of patients with primary Renal SCC.
The mainstay of treatment has been surgery by either a
radical nephrectomy or nephroureterectomy [1,4–9].
Most patients with loco-regional disease do not have
accurate lymph node staging.[13] Further studies are
required to determine whether chemotherapy or
radiotherapy will improve patient survival[15].
Although prognosis of SCC is the same in stage-wise
as urothelial cancers, they usually occur in advanced
stages. [16,17,20]
Some benefit has however been suggested with
adjuvant chemotherapy in patients with urothelial
carcinoma of the upper urinary tract [13]. Primary renal
squamous cell carcinomas are very uncommon

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tumours which are often not clinically suspected or
diagnosed. On Comparing with previous case
reports, most patients die around 6 weeks of surgery
but the patient in the current study survived for more
than 18 months post radical nephrectomy possibly
because of localised treatment effect of radiotherapy
and taxanes plus platinum based chemotherapy. Even
in metastatic tumours, Radical nephrectomy and
Lymph nodal dissection have a role. Anti-EGFR
therapy is under study for such cases.
CONCLUSION
Primary Renal squamous cell carcinomas are very
rare tumours which are often not clinically suspected
or diagnosed. These tumours require thorough clinical
examination, radiological workup, aggressive
approach towards treatment to add years in their life
owing to worse prognosis and highly proliferative
variety of the primary. Currently, Radical
Nephrectomy with lymph nodal dissection is the
mainstay but Radiotherapy for localised disease and
chemotherapy for palliative treatment is observed to
increase survival in these patients.
Conflicts of Interest-The authors have no confict of
interest to declare.
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