British Journal of Urology (1998), 82, 918–919

CASE RE PORT

Squamous cell carcinoma of the renal pelvis with invasion ofthe infradiaphragmatic inferior vena cavaS.J . OH, D.J. LIM, J.Y. CHO, S.H. KIM and S.E. LEEDepartments of Urology and Radiology, Seoul National University College of Medicine, Seoul, Korea

of repeated urinary cytology was negative, there was noCase report

preoperative indication of the origin of the renal pelvistumour. Although there was no evidence of regional orA 71-year-old woman presented with right upper quad-

rant discomfort, associated with a 4 kg weight loss overa 3-month period. Physical examination revealed mildtenderness of the right costovertebral angle. Her haemo-globin level was 9.3 g/dL and the haematocrit 27.7%;preoperative urinary cytology revealed no malignantcells. Ultrasonography (US) and CT showed a diCusemass involving the right kidney and tumour thrombusin the renal vein, extending to the inferior vena cava(IVC) (Fig. 1). There was no evidence of regional ordistant metastasis. On US, direct invasion of the IVCmass, uncommon in RCC, was suspected. Under a diag-nosis of RCC of the right kidney with infrahepatic IVCthrombosis, radical nephrectomy with inferior venacavalthrombectomy was performed. The lymph node was notenlarged, but due to moderate adhesion, renal hilardissection was diBcult. En bloc lymphadenectomy withexcision of the thrombus, together with the ellipse of thevena cava around the right renal vein, was completed.Pathological examination revealed squamous cell carci-noma of the renal pelvis. Grossly, the specimen consistedof a poorly circumscribed whitish-grey hard mass, replac-ing most of the right kidney. Microscopically, the tumourextended into Gerota’s fascia, the adrenal and wall ofthe IVC, and focally there was squamous metaplasia ofthe renal pelvis (Fig. 2). Four months later she wasreferred to our department with local recurrence in theright renal fossa.

Comment

Squamous cell carcinoma of the renal pelvis is a veryrare malignancy and in only one reported case [1],confirmed by needle biopsy in a patient who refused

a

b

Fig. 1. a, Contrast-enhanced CT scan showing an ill-definedfurther treatment, did it extend to the IVC. The presentheterogeneous mass (black arrows) diCusely involving the entirepatient had squamous cell carcinoma invading the IVC,right kidney, with extension to the retrocaval space. A low-pathologically confirmed by radical nephrectomy andattenuation filling defect is seen in the IVC (curved arrow),

thrombectomy of the IVC. In this patient it was very suggestive of tumour thrombus. b, On a longitudinal ultrasonog-diBcult to determine, once the mass had enlarged sig- ram, the mass (arrows) is almost continuous with the IVCnificantly, whether the tumour of the renal parenchyma thrombus (arrowheads) abutting broadly onto the IVC wall

(curved arrows).extended to the renal pelvis or vice versa. As the result

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CAS E REPORT 919

distant metastasis, the tumour was locally advanced atthe time of diagnosis.

Reference

1 Kibel AS, Downs TM, Bubley GJ, DeWolf WC. Squamous cellcarcinoma of the renal pelvis with inferior vena cavalextension. J Urol 1996; 156: 1436

Authors

S.J. Oh, MD. Research Fellow.D.J. Lim, MD. Resident.J.Y. Cho, MD. Fellow.S.H. Kim, MD. Professor.S.E. Lee, MD. Professor.Fig. 2. The tumour mass consisted of characteristically keratinizedCorrespondence: Dr S.E. Lee, Department of Urology, Seoulcells containing concentric aggregates of ‘squamous pearl’.National University Hospital, Yunkeun-Dong 28, Chongno-Ku,Seoul 110-744, Korea.

© 1998 British Journal of Urology 82, 918–919