Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis

A case of sarcomatoid transitional cell carcinoma of the renal pelvis is reported. It was distinguished from carcinosarcoma by immunohistochemical study. The tumor was difficult to distinguish from a renal parenchymal tumor in imaging studies because it originated from a duplicated renal pelvis.     

Synchronous ipsilateral conventional renal cell and transitional cell carcinoma

Simultaneous occurrence of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) in the same kidney is unusual. We report a 61-year-old man with ipsilateral synchronous renal adenocarcinoma and renal pelvic TCC. He was referred to our department for gross hematuria and right flank pain. CT and MRI studies revealed a 57 × 50 mm irregular and infiltrative upper right kidney mass with necrotic components. A right radical nephrectomy was done. Pathological diagnosis was a high grade tumor originating from just beneath the intact urothelium of renal pelvis and infiltrating through the parenchyma showing solid and occasional tubular growth patterns. A second tumor in close proximity to the first was reported as well differentiated RCC. This is a rare case of combined renal malignancies.     

Single primary lung cancer consisting of three cancer cell types (small cell carcinoma, adenocarcinoma, and squamous cell carcinoma) in which each had metastasized to different lymph nodes

We report a case of a 70-year-old male smoker with a single primary tumor 2.5 x 3.0 cm in size in the right lung lower lobe. A transbronchial lung biopsy revealed squamous cell carcinoma of the lung. We performed right lower lobectomy with lymph node dissection (ND2a). The resected specimen consisted of three different cell types; small cell carcinoma, adenocarcinoma and squamous cell carcinoma (in a ratio of 70: 20: 10). Each cancer cell types had metastasized to different lymph nodes. The final diagnosis was a combined small cell carcinoma in the lung. Combined small cell carcinoma is uncommon, but is nevertheless a well-described diagnostic category in lung cancers.     

Sarcomatoid Squamous Cell Carcinoma of the Right Renal Pelvis with Liver Metastasis: Case Report

We report on a man with sarcomatoid squamous cell carcinoma of the right kidney with liver metastases. Bilateral renal lithiasis and well differentiated squamous cell carcinomas of the right renal pelvis were also noted. This uncommon case is discussed and the literature is reviewed.     

Sarcomatoid squamous cell carcinoma of the penis: a clinical and pathological study of 5 cases

PURPOSE: We analyzed clinical, morphological and immunohistochemical features in 5 cases of sarcomatoid or spindle cell squamous cell carcinoma of the penis. MATERIALS AND METHODS: The clinical and pathological files of all patients with penile carcinoma treated at our hospital between 1956 and 2002 were reviewed. Cases diagnosed as sarcomatoid squamous cell cancer were selected. RESULTS: Five of 341 patients (1.4%) had sarcomatoid penile carcinoma. Tumor stage was T2N0 in 2 patients, T2N2 in 2 and T4N3 in 1. In all patients partial or total penectomy was eventually performed. Three patients underwent bilateral inguinal lymphadenectomy. Four of 5 patients had distant metastatic disease and died within 1 year after diagnosis. One patient had exclusive hematogenous spread without lymph node involvement. Foci of distant metastatic tumor sites were the lung, skin, bone, pericardium and pleura. In 4 patients the diagnosis was based on the expression of keratin filaments in a predominantly spindle cell penile tumor or by the identification of carcinomatous and sarcomatoid areas on hematoxylin and eosin stained slides of the primary tumor. In 1 case a squamous component in a lymph node metastasis rendered the keratin negative spindle cell primary tumor sarcomatoid squamous cell carcinoma. CONCLUSIONS: Sarcomatoid squamous cell carcinoma of the penis is a subtype of squamous cell carcinoma with a poor prognosis often associated with wide hematogeneous spread. It is a rare malignancy that is often difficult to diagnose, requiring additional immunohistochemical stains.     

Squamous cell carcinoma of the renal pelvis and ureter: incidence, symptoms, treatment and outcome

PURPOSE: Squamous cell carcinomas of the renal pelvis and ureter are rare. We report a large series of patients and compare it to patients with urothelial carcinoma. MATERIALS AND METHODS: The initial material was comprised of 808 patients with renal pelvis or ureteral cancer. A review of the histopathological material and clinical records was performed. RESULTS: Only 2 (4%) of 65 patients with squamous cell carcinoma had stage pTa/pT1/pT2 tumors compared to 460 (62%) of 743 patients with urothelial carcinoma. Median survival was much shorter for surgically treated patients with squamous cell carcinoma compared to those with urothelial carcinoma (7 vs 50 months). However, there was no significant difference in the disease specific 5-year survival rate between patients with squamous cell carcinoma and urothelial carcinoma in the same disease stage. Vascular invasion, microscopic solid tumor pattern and large tumor size had negative prognostic significance in multivariate analyses. Histopathological tumor type (squamous cell carcinoma or urothelial carcinoma) had no prognostic significance. CONCLUSIONS: The prognosis for squamous cell carcinoma is poor, but stage for stage the prognosis is not different between patients with urothelial carcinoma and squamous cell carcinoma of the renal pelvis and ureter. It can be presumed that high stage squamous cell carcinoma and urothelial carcinoma become symptomatic first at a time when the tumors already are large, deeply invasive and most often incurable. New treatment modalities are urgently needed to improve the poor prognosis in patients with advanced stage squamous cell carcinoma and urothelial carcinoma of the upper urinary tract.     

Cardiac metastasis from a transitional cell carcinoma diagnosed by two-dimensional echocardiography

We report a rare case of symptomatic cardiac metastasis from a transitional cell carcinoma of the renal pelvis. A 57-year-old man presented with severe anemia, inflammation, hypoxemia and disseminated intravascular coagulation. Computed tomography revealed a large tumor in the left renal pelvis with multiple lymph node metastases. Two-dimensional echocardiography revealed large tumors in the right ventricle. The patient suddenly died because of the obstructive mass of the right ventricular outflow tract. Histopathological examination showed high-grade transitional cell carcinoma in the left renal pelvis and the right ventricle. There are only three cases of cardiac metastases from a transitional cell carcinoma reported in the literature.     

Squamous cell carcinoma of renal pelvis: a case report and review of the Japanese literature

Squamous cell carcinoma of renal pelvis is relatively rare and its prognosis is very poor. A 72-year-old man was introduced to our institute because of macroscopic hematuria. He had no history of urolithiasis or urinary tract infection. Excretory urography showed a nonfunctioning right kidney. Cytologic examination of urine was positive for malignant cell from squamous cell carcinoma. Preoperative diagnosis was made as right renal pelvic tumor, but it appeared to be renal tumor on the roentgenogram. Right radical nephrectomy and transurethral ureterectomy was performed. Radiation therapy was done after operation. Pathological diagnosis was squamous cell carcinoma of renal pelvis extensively infiltrating to the renal parenchyma. The patient is alive with no recurrence or metastasis for eight months after operation. Statistical analysis was made on 136 cases of squamous cell carcinoma of renal pelvis reported in the Japanese literature including our case, and this disease is also briefly reviewed.     

Squamous cell carcinoma in the renal pelvis of a horseshoe kidney

We report a rare case of squamous cell carcinoma in the renal pelvis of a horseshoe kidney. An 80-year-old woman was referred to the National Nagano Hospital for the examination of occult blood in her urine. Microscopic hematuria was found, but pyuria was not seen. Computed tomography and magnetic resonance imaging showed a mass in the left renal pelvis of the horseshoe kidney. No renal stone or hydronephrosis was found. Cytopathological examination in the voided urine specimen was positive. Left nephroureterectomy with the splitting of the isthmus of the horseshoe kidney was performed without renal pedicle clamping using a microwave tissue coagulator. No bleeding was encountered after separating the isthmus. A final pathological diagnosis of squamous cell carcinoma with a tumor thrombus was made. Lymph node metastasis had developed and rapidly progressed and the patient died of disseminated malignancy 4 months after the operation. We reviewed 24 cases of renal pelvic tumor in horseshoe kidneys previously reported in Japan. Seven cases (30%) included components of squamous cell carcinoma. The incidence is higher than that of renal pelvic tumors in the general population.     

Squamous cell carcinoma of the renal pelvis. A clinical case

Squamous cell carcinoma of the renal pelvis is uncommon, accounting for approximately 10% of all renal pelvic tumours. It's often associated with chronic renal calculi or infection and it usually presents at an advanced stage with pain or a palpable mass. We report an incidental case of squamous cell carcinoma of the renal pelvis, associated with chronic renal calculi and infection, and weight loss. The prognosis of patients with advanced squamous cell carcinoma of genitourinary origin is poor. In patients with chronic stones or infection squamous cell carcinoma of renal pelvis must be suspected if survival is to be affected.     

Granulocyte-colony stimulating factor producing squamous cell carcinoma of the renal pelvis: a case report

We report a case of granulocyte-colony stimulating factor (G-CSF)-producing squamous cell carcinoma of the renal pelvis. A 71?year-old woman presented with gross hematuria and leucocytosis of 21,300/mm3 (neutrophil : 86%) in the peripheral blood, but with no focus of infection. Right renal pelvic mass was found at a nearby hospital and she was referred to our hospital for examination and treatment. We performed right nephroureterectomy for a right renal pelvic tumor. Hematoxylin-eosin staining revealed squamous cell carcinoma of the renal pelvis and tumor cells stained strongly positive for G-CSF. According to these histopathological findings, we diagnosed this case as G-CSF-producing squamous cell carcinoma of the renal pelvis. She is presently alive without any new recurrent lesions for 12 months.     

A case report of renal pelvic squamous cell carcinoma

We describe a case of a 75-year-old woman with squamous cell carcinoma in the right renal pelvis accompanied by multiple dysplasia in the upper urinary tract. Though it is difficult to make a preoperative diagnosis of squamous cell carcinoma, lavage cytology is particularly valuable. Renal arteriography and cross-sectional imaging are also useful to assess an accurate stage. We postulate that severe dysplasia could be a precursor of squamous cell carcinoma as well as transitional cell carcinoma.     

Squamous cell carcinoma of the renal pelvis with giant hydronephrosis

We report a case of squamous cell carcinoma of renal pelvis associated with giant hydronephrosis. A 71-year-old woman presented to our hospital with a complaint of abdominal fullness due to the right giant hydronephrosis. Although the diagnosis of her hydronephrosis was made about 20 years ago at another hospital, it had been left untreated. Computed tomography showed the right hydronephrosis of 20 x 20 x 25 cm in diameter and no evidence of tumor or calculus in the right urinary tract. For relief of her complaint, right nephrectomy was performed. The fluid content was bloody and 4,200 ml in volume. Histological examination revealed a flat type squamous cell carcinoma of the renal pelvis. This is the 30th case of renal pelvic malignant tumor associated with giant hydronephrosis reported in Japan. The literature was reviewed and the management of giant hydronephrosis was discussed.     

肾盂鳞状细胞癌的诊断与治疗(附16例报告)

目的：探讨肾盂鳞状细胞癌的术前诊断及治疗效果。方法：回顾性分析16例肾盂鳞状细胞癌患者的诊断和治疗等临床资料。所有患者术前均行IVU检查，13例行B超检查，4例行CT和MRI检查；11例行根治性肾切除加局部淋巴结清扫术。结果：行IVU检查者仅提示4例有占位性变病，13例行B超检查者仅显示2例有占位性病变，4例行CT或MRI检查者均提示有肿瘤改变。近50％的患者术后1年内死亡。结论：术前诊断肾盂鳞状细胞癌的敏感方法为CT和MRI，其治疗方法首选根治性肾切除术，但预后差。     

Squamous cell carcinoma of the renal pelvis manifesting after percutaneous nephrolithotomy for long standing calculus

Squamous cell carcinoma of the renal pelvis is a rare neoplasm and is usually associated with long standing stone disease. The disease is aggressive in nature and usually has a poor prognosis. We report a case of renal lithiasis who underwent successful percutaneous nephrolithotomy (PCNL) for renal pelvic calculus, and eight months later presented with a large invasive squamous cell carcinoma in the same location.     

Squamous cell carcinoma of the renal pelvis with inferior vena caval extension

BACKGROUND: We report here on a third case of squamous cell carcinoma (SCC) of the renal pelvis extending to the inferior vena cava. METHODS/RESULTS: A 48-year-old man was diagnosed with an advanced left renal pelvic tumor on computed tomography. He had undergone extracorporeal shock wave lithotripsy for left staghorn calculi 10 years ago. An inferior vena cavagram showed tumor thrombus extending to the inferior vena cava. Percutaneous left renal biopsy revealed SCC. The patient received three courses of combination chemotherapy with cisplatin, bleomycin and etoposide. However, 1 month after the last course of chemotherapy, he died of cancer progress. CONCLUSION: This is the third case of SCC of the renal pelvis extending to the inferior vena cava in the world.     

肾盂鳞状细胞癌临床特点分析

目的 探讨肾盂鳞状细胞癌的诊治特点.方法 回顾性分析1991年10月至2009年5月收治8例肾盂鳞状细胞癌患者资料.临床表现血尿8例,腰痛7例,腹部包块1例.B超检查8例,IVU检查8例,CT检查4例.术前诊断为肿瘤3例,诊断为肾结石5例,结石术中发现肿瘤并经冰冻病理确诊2例.8例患者均经手术治疗,行根治性肾输尿管切除4例、单纯性肾切除3例、姑息性切除术1例.结果 8例病理诊断均为鳞状细胞癌.中分化6例,高分化和低分化各1例;pT1 1例,pT2 1例,pT3 3例,pT4 3例;淋巴结转移2例.获随访7例,失访1例.术后生存时间2～42个月,中位时间6个月,患者均死于肿瘤复发及转移.结论 肾盂鳞状细胞癌恶性程度高,常合并结石,术前诊断困难,确诊时多为中晚期,术后短期内易复发转移,预后极差.

Abstract：

Objective To review the diagnosis and treatment of squamous cell carcinoma of renal pelvis. Methods The clinical data from October 1991 to May 2009 of eight cases of squamous cell carcinoma of renal pelvis were reviewed and analyzed retrospectively. The symptoms of the patients were hematuria (eight cases), pain (seven cases) and abdominal mass (one case). All patients underwent B-ultrasound and IVU examination and four cases underwent CT scan. Three cases were diagnosed as having a tumor before surgery. Five cases were diagnosed as renal calculus, two of the five cases were diagnosed by intraoperative frozen section. Radical nephroureterectomy were performed in four cases, nephrectomy in three cases and palliative resection in one case. Results Histological classification revealed that six cases were moderately differentiated, one case was well differentiated and one case was poorly differentiated. Two cases had stage pT1/pT2 and six cases had stage pT3/pT4. 2 cases had regional lymph nodes metastasis. Seven cases were followed-up. All patients died of tumor recurrence or metastasis. The median tumor specific survive time was six months (range from two months to 42 months). Conclusions Squamous cell carcinoma of renal pelvis is often occurs concurrently with urolithiasis which could lead to difficulty in diagnose before operation. As the most of the patients were diagnosed with advanced stage disease, squamous cell carcinoma of renal pelvis tended to early recurrence and metastasis and the prognosis was very poor.     

Combined large cell neuroendocrine carcinoma

We report a case of combined large cell neuroendocrine carcinoma. A 78-year-old man with vertigo was referred to our hospital where chest X-ray revealed a tumor shadow in the right lung. A transbronchial lung biopsy specimen verified a diagnosis of non-small cell lung carcinoma (cT1N0M0). Right lower lobectomy with mediastinal lymph node dissection (#7,8,9) was performed. A postoperative histological diagnosis was combined large cell neuroendocrine carcinoma of a component of squamous cell carcinoma [pT4 (pm) N2M0]. The patient received concurrent chemoradiotherapy due to upper mediastinal lymph node metastasis 4 months after surgery. The chemoradiotherapy well responded and the patient remains well 9 months after surgery.     

Sarcomatoid carcinoma of the renal pelvis with giant cell tumor-like features: Case report with immunohistochemical findings

Sarcomatoid transitional cell carcinoma is a rare entity, in which a malignant, overtly epithelial component coexists with areas having a sarcoma-like appearance. Histological distinction of sarcomatoid carcinomas from carcinosarcomas is often difficult and immunohistochemistry is a helpful diagnostic adjunct in the correct diagnosis. In the present report, we describe an uncommon case of sarcomatoid transitional cell carcinoma of the renal pelvis, associated with giant cell tumor-like features. Immunoperoxidase staining for cytokeratin was positive in spindle cell component, indicating an epithelial origin. The carcinomatous component showed a diffuse membranous reactivity for E-cadherin, whereas the reactivity was sporadic and weaker in the sarcomatoid component, suggesting that the decrease of E-cadherin expression might be associated with the acquisition of sarcomatous morphology. Osteoclast-like multinucleated giant cells were positive for CD68 and negative for p53 oncoprotein, suggesting that they represent a non-neoplastic component that is reactively induced in the tumor stroma.     

Two cases of squamous cell carcinoma of upper urinary tract with hypercalcemia

We report two cases of squamous cell carcinoma of upper urinary tract with hypercalcemia. Case 1; a 54 year old female with primary squamous cell carcinoma (SCC) of right ureter showed marked hypercalcemia and leukocytosis. High levels of serum parathyroid hormone-related peptide (PTHrP) and granulocyte colony stimulating factor (G-CSF) were detected. Although chemotherapy of cisplatin and 5-fluorouracil with radiotherapy was effective, thereafter recurrence was occurred in renal pelvis, and the patient died 17 months after the initiation of therapy. Case 2; a 54 year old male of primary SCC of right renal pelvis with local lymphadenopathy and anterior mediastinal metastases showed marked hypercalcemia. High levels of PTHrP were detected. Although the patient was administered UFT with palliative radiotherapy to the anterior mediastinum, he died 2 months after the initiation of therapy. To our knowledge, the case 1 is the third case that of the high levels of serum PTHrP and G-CSF simultaneously in squamous cell carcinoma of upper urinary tract.