Staghorn morphometry-based prediction algorithms may predict the number of tract(s) and stage(s) for PCNL monotherapy. New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported, but have not shown utilization in staghorn cases. Wideband doppler ultrasound and real-time virtual sonography can assist. Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus. Non-contrast computerized tomography (NCCT) is indeed the standard imaging tool for percutaneous nephrolithotomy (PCNL) additional tools such as three-dimensional computed tomography (CT) reconstruction of the staghorn calculus may help plan access in complex cases. We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones. In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition. Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones. We encountered a rare case of renal SCC with renal calculus.Staghorn calculi present a particular and challenging entity of stone morphology. When a patient with a renal staghorn calculus shows elevated serum SCC markers, the coexistence of SCC should be considered. In order to detect tumor aggressiveness before treatments are administered, the evaluation of serum SCC markers is recommended. In the present case, CT showed a large staghorn calculus with hydronephrosis and a stretched renal cortex.Īdvanced SCC has a poor prognosis, and adjuvant chemotherapy or radiation therapy has not been established for SCC. It is difficult to distinguish primary renal SCC from xanthogranulomatous pyelonephritis or other malignant neoplasms of the kidney preoperatively. In many cases, the renal parenchyma shows a degraded density. CT shows a diffuse, swollen kidney with thinning of the cortex and renal calculi and perirenal infiltration. The radiographic characteristics of renal SCC are variable. Based on these findings, we hypothesized that the renal calculus might have initially provoked the metaplasia, with the squamous metaplasia subsequently exacerbating the calculus, leading to a vicious cycle and conclusive squamous carcinogenesis. Some previous studies have mentioned that patients with renal SCC had chronic episodes of pyelonephritis or nephrolithiasis. The coexistence of calculi has been reported in many (approximately 90%) cases of renal SCC. Some studies have reported that urothelial epithelium may lead to squamous metaplasia with chronic irritation or inflammation, which progresses to dedifferentiation, dysplasia, and ultimately to carcinogenesis. Whether or not renal calculi cause SCC is unclear. The prognosis for renal SCC is extremely poor, and less than 10% of patients survive for 5 years. Renal SCCs are reported to be aggressive tumors with a worse prognosis than other urinary tract carcinomas because they tend to be detected in an advanced stage (pT3 or greater). In the urinary tract, the most frequent neoplasms are urothelial carcinomas SCC in the renal pelvis is rare and only accounts for 0.5% of malignant renal tumors. The final diagnosis was SCC of the left kidney, and after the operation, the serum SCC marker level was 4.8 ng/mL. Her disease's T stage was assumed to be at least pT3. As her kidney had been broken into two pieces, it was difficult to decide whether or not the surgical margin was positive. Based on these findings, a diagnosis of SCC rather than urothelial carcinoma or renal cell carcinoma was made. Immunohistochemical staining showed that GATA3 and P40 were negative, while CK5/6 was positive (Fig. This finding suggested that the tumor was derived from the squamous metaplasia due to the staghorn calculus. We were able to detect the area where the urothelial epithelium and squamous epithelium were mixed. Foam cells were invading the renal parenchyma, suggesting xanthogranulomatous pyelonephritis. A pathologic examination revealed that the tumor was SCC accompanied by a cancer pearl (Fig. Due to severe adhesion, the kidney was divided into two pieces and removed (Fig. Three months after her initial visit to our department, she underwent open nephrectomy. b Two additional nephrostomies were performed. A CT revealed that the middle and inferior calyxes were not drained adequately.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |