BERKELEY, CA (UroToday.com) - By publishing our recent case report, we wanted to highlight this most unusual presentation of an upper tract carcinoma. To our knowledge this was the first reported association between squamous cell carcinoma and perinephric abscess. Actually, we did not initially suspect neoplasia, and the condition was treated as an abscess, with intravenous antibiotics and percutaneous drainage. Nephrectomy was performed due to the worsening state of the patient, in spite of these measures.
The presence of a choraliform stone may have triggered the process of metaplasia and malignization, leading to the genesis of the squamous cell carcinoma in our case. The subsequent infection may have thrived in the necrotic portions of the tumor, extending to the perinephric space. Actually, the final open surgical approach was rather difficult due to the intense inflammatory reaction present at the retroperitoneum.
The fact that we did not anticipate finding a malignant neoplasm in this case might have had serious consequences had the patient survived for long. The risks of tumor seeding during the percutaneous drainage are deemed to be very small, but real, although squamous cell tumors are less prone to seeding than transitional cell carcinomas. Squamous cell carcinomas of the upper urinary tract usually have a poor prognosis due to the advanced stage at presentation and to the lack of response to systemic therapy.
Prompt diagnosis and treatment are crucial for the resolution of the infectious complications and to reduce morbidity and mortality rates in similar cases; our patient died of sepsis in the postoperative period in spite of receiving intravenous antibiotics, of an uneventful drainage, and of a subsequent radical nephrectomy.
The presence of an upper tract carcinoma should be considered in all patients with perinephric abscesses, and the surgical technique should take this into consideration.
Busby, J. E., Brown, G. A., Tamboli, P. et al. Upper urinary tract tumors with nontransitional histology: a single-center experience. Urology, 67: 518, 2006
Gardiner, R. A., Gwynne, R. A., Roberts, S. A. Perinephric abscess. BJU Int, 107 Suppl 3: 20, 2011
Gustavo Carvalhal and Daniel Rauber as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Santo Inácio, 500 apt. 501, 90570-150 Porto Alegre, RS, Brazil