病例報告: 腎臟鱗狀上皮細胞癌

蔡佳宏¹、劉惠瑛¹

高雄長庚紀念醫院 泌尿科¹

Chia-Hung Tsai¹, Hui-Ying Liu¹

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan¹

 

Squamous cell carcinoma (SCC) of kidney is a rare disease which renal calculi, chemical abuse, hormonal imbalances, and chronic irritation or inflammation have been implicated in the pathogenesis of this poor prognosis disease. We present a case with the initial diagnosis of right flank cellulitis. This patient received emergent surgical intervention due to rapid progression to necrotizing fasciitis involving right flank and right abdomen. The pathologic report revealed squamous cell carcinoma of kidney and extent to adjacent organs.

  A 70-year-old man with background history of renal stone with extracorporeal shock wave treatment 30 years ago. He had chronic kidney disease and hypertension under regular medication treatment. This time he suffered from general edema and ascites for 3 weeks. Associate symptoms including general weakness, poor appetite, and body weight loss (10kg in a few months). He visited nephrology outpatient department and right flank cellulitis was impressed. He was admitted to general ward for antibiotic treatment and further survey. Abdomen CT was arranged due to the progression of sepsis. The CT revealed right renal mass with secondary gas forming infection and local invasion to second portion duodenum, right psoas muscle, right retroperitoneum and right lower back, causing gas forming abscess in right lower back and right lower abdominal wall. Urologist was consulted and performed emergent incision and debridement operation. Multiple lobulated abscess were identified and drained out as much as possible. One lower polar renal mass was resected partially. He was transferred to intensive care unit with open drainage. The pathological report confirmed the renal tumor as squamous cell carcinoma. He received two more debridement operation and the infection status improve gradually. However, the tumor rapid progression was noted on CT follow up two weeks later. Due to deteriorating condition and unresectable tumor status, he received palliative treatment and expired after one month.

  Squamous cell carcinoma is account for 0.5% ~ 0.8% of malignant renal tumor. History of renal stone may be a risk factor to this malignant tumor. SCC of kidney is more invasive than most urothelial carcinoma. It is usually associated with advanced stage at diagnosis and a poor prognosis. Our patient was initially diagnosed as cellulitis and pyelonephritis. The disease progressed under antibiotic treatment and further image study revealed this advance tumor. Surgical intervention was arranged and confirmed the diagnosis of SCC. However, due to wide spread of the tumor that result in multiple organ failure, he died after one month of the diagnosis. How to identify these patients early and apply adequate treatment required further study.