Cutaneous fistula, a rare presentation of squamous cell carcinoma of the renal pelvis

Cutaneous fistula, a rare presentation of squamous cell carcinoma of the renal pelvis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cutaneous fistula, a rare presentation of squamous cell carcinoma of the renal pelvis abdelrahman abdelkader This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1385406/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Renal cell carcinoma with all its variants represent more than ninety percent, the remaining ten percent is divided on urothelial tumors, sarcomas and metastasis from other organs. Squamous cell carcinoma of the renal pelvis is mentioned very few due to its rarity. Until now there is no guideline for managing it unlike transitional cell carcinoma. Our case is very rare, one or two case all over the world has been reported to our knowledge, also the treatment plan which was salvage surgery was very successful. Case presentation : This article will discuss a male patient who developed squamous cell carcinoma in the renal bed after nephrectomy, managed with excellent outcome in Assiut university hospital. After 8 month the patient show good and excellent performance. Conclusions : The general rule of this type of malignancy is that it is resistant to both chemo and radiotherapy with good outcome to surgery if early intervention was done. Our case could provide a beacon for similar cases. ESRD rare recurrent surgery salvage Background The most common variant of renal cell carcinoma in ESRD patients is papillary renal cell carcinoma (1,2). Squamous cell carcinoma of the renal pelvis is a very rare variant, its incidence range from less than1 percent to less than 5-10 percent of all the upper urothelial tract tumors (3,4). Squamous cell carcinoma in ESRD is mentioned in the literature very few, There is no definite cause to blame, but smoking, recurrent operation as PCNL, chronic irritation caused by stones or infection and squamous metaplasia are risk factors (5–7) .The most common cause is stones leading to squamous metaplasia, which was found in the previous kidney specimen that was removed from the patient two years ago. Squamous metaplasia considered by some authors as precancerous lesion, occurs more in the lower tract unlike the upper tract, and requires strict follow up (5,8). The clinical presentation of the disease includes no characteristic symptoms and signs, making it very difficult to diagnose as in this case the diagnosis was difficult, all the signs were making the diagnosis directed toward infection or retro-peritoneal abscess also the CT guided biopsy was not conclusive, until exploration was done (9). Pain, hematuria, local swelling of the loin and fistula formation or skin sinus as in our patient are symptoms that may occur in advanced disease (5,7,10). The treatment is radical surgery, due to the rarity of the cases the conclusive decision of applying radiotherapy or chemotherapy either in advanced or early cases, preoperatively or postoperatively, can’t be taken (10–12) .To achieve similar outcome as transitional cell carcinoma the diagnosis must be early, as the main problem with this variant is its delayed diagnosis either according to the clinical picture or to radiological imaging (13). Case Presentation A male patient 47 years hypertension, on regular dialysis for eleven years due to ESRD , no other comorbidity were found beside history of a lower urinary tract surgery 17 years ago and a left sub-capsular nephrectomy 2019 at our department because he was complaining of persistent pyuria per urethera . After two years he presented with left loin pain and swelling that kept increasing in size and then eventually a skin sinus developed. MRI was done and showed a large lobulated mass at site of renal bed infiltrating the psoas muscle and lateral wall muscle measuring 14.5*7.5 cm with restricted diffusion. After reviewing his old biopsy it showed squamous metaplasia of the pelvicalyceal system and chronic glomerulonephritis. A Ct guided biopsy was done revealing areas of hyperplastic squamous epithelium, strips of chronic inflammatory cellular infiltrate & the cells showed prominent nucleoli with occasional mitosis and extensive keratinization. His labs were within normal serum creatinine was five, hemoglobin was ten. Urgent salvage surgery was performed. A chevron incision was done, adhesiolysis and dissection of massive peritoneal and colonic adhesion until the retroperitoneal space is reached. A fungating mass is found infiltrating most of the posterior abdominal wall muscles and the rib, it was found to infiltrate part of omentum. Excision of the mass and most of the necrotic tissue, closure was done in layers despite the difficulty we faced due to the extensive loss in tissue architecture resulting from extensive infiltration of the tumor. The patient had a smooth postoperative recovery and drain was removed after five days, the wound showed some discharge which was trivial. He was discharged after 9 days. He was presented in the follow up after three month with satisfactory performance and a good wound healing. His biopsy showed moderately differentiated squamous cell carcinoma. Conclusion Squamous cell carcinoma of renal pelvis is rare and highly aggressive. It has a high recurrence rate and low mean survival rate. Best treated by surgery. Squamous metaplasia should not be neglected . Stones, infection should be managed as early as possible with prevention of their recurrence. Nephrectomy in case of complicated renal disease should be radical. Regular follow up cystoscopy is required. Abbreviations ESRD –End Stage Renal Disease. MRI-Magnetic Resonance Imaging. CT- Computed tomography. References 1. Brits NF, Bulane S, Wadee R. Primary squamous cell carcinoma of the kidney: a case report and review of the literature. African Journal of Urology. 2020 Dec 3;26(1):79. 2. Bhaijee F. Squamous cell carcinoma of the renal pelvis. Annals of Diagnostic Pathology. 2012 Apr;16(2):124–7. 3. Tickoo SK, dePeralta-Venturina MN, Harik LR, Worcester HD, Salama ME, Young AN, et al. Spectrum of Epithelial Neoplasms in End-Stage Renal Disease: An Experience From 66 TumorBearing Kidneys With Emphasis on Histologic Patterns Distinct From Those in Sporadic Adult Renal Neoplasia. American Journal of Surgical Pathology. 2006 Feb;30(2):141–53. 4. Nakanishi Y, Koga F, Fukushima H, Motoi T, Tobisu K. Renal Cell Carcinoma in EndStage Renal Disease [Internet]. Updates in Hemodialysis. IntechOpen; 2015 [cited 2021 Oct 7]. 5. Chang T-H, Tseng J-S. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature. Open Med (Wars). 2021 Jan 12;16(1):128–33. 6. Genega EM, Porter CR. Urothelial Neoplasms of the Kidney and Ureter. Pathology Patterns Reviews. 2002 Jun 1;117(suppl_1):S36–48. 7. Sun X, Li Y. Incidental squamous cell carcinoma of renal pelvis presenting as skin invasion: a case report. Journal of Medical Case Reports. 2020 Dec 15;14(1):244. 8. Ganeshappa A, Krambeck A, Grignon DJ, Lingeman JE. Endoscopic Management of Keratinizing Desquamative Squamous Metaplasia of the Upper Tract: A Case Report and Review of the Literature. Journal of Endourology. 2009 Aug;23(8):1277–9. 9. Jiang P, Wang C, Chen S, Li J, Xiang J, Xie L. Primary renal squamous cell carcinoma mimicking the renal cyst: a case report and review of the recent literature. BMC Urology. 2015 Jul 23;15(1):69. 10. Ghosh P, Saha K. Primary Intraparenchymal Squamous Cell Carcinoma of the Kidney: A Rare and Unique Entity. Case Reports in Pathology. 2014 Jan 20;2014:e256813. 11. Martin JW, Carballido EM, Ahmed A, Farhan B, Dutta R, Smith C, et al. Squamous cell carcinoma of the urinary bladder: Systematic review of clinical characteristics and therapeutic approaches. Arab Journal of Urology. 2016 Sep;14(3):183–91. 12. Hosseinzadeh M, Mohammadzadeh S. Primary Pure Squamous Cell Carcinoma of Kidney Associated with Multiple Stag Horn Stones. Int Med Case Rep J. 2020;13:261–3. 13. Sahoo TK, Das SK, Mishra C, Dhal I, Nayak R, Ali I, et al. Squamous Cell Carcinoma of Kidney and Its Prognosis: A Case Report and Review of the Literature. Case Reports in Urology. 2015;2015:1–3. Declarations -Ethics approval and consent to participate : number is not required by our faculty of medicine laws -Consent for publication : obtained from the patient prior to the intervention -Availability of data and material : available -Competing interests : NO -Funding : NO -Authors' contributions : AM wrote the manuscript , MA is the operator and reviewed the manuscript. -Acknowledgements : NO -Authors' information (optional): obtained Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1385406","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":96102741,"identity":"ef5cdaec-7ca9-444c-8a13-2267e0712d1d","order_by":0,"name":"abdelrahman abdelkader","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-1217-7279","institution":"Assiut University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"abdelrahman","middleName":"","lastName":"abdelkader","suffix":""}],"badges":[],"createdAt":"2022-02-22 14:16:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1385406/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1385406/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19987843,"identity":"a2837283-4c0b-47ac-b9ab-5033aaed342a","added_by":"auto","created_at":"2022-04-05 17:57:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":137817,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1385406/v1/2c68e38a-f9ff-4900-8c79-7124f12173f7.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eCutaneous fistula, a rare presentation of squamous cell carcinoma of the renal pelvis\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe most common variant of renal cell carcinoma in ESRD patients is papillary renal cell carcinoma (1,2). Squamous cell carcinoma of the renal pelvis is a very rare variant, its incidence range from less than1 percent to less than 5-10 percent of all the upper urothelial tract tumors (3,4). Squamous cell carcinoma in ESRD is mentioned in the literature very few, There is no definite cause to blame, but smoking, recurrent operation as PCNL, chronic irritation caused by stones or infection and squamous metaplasia are risk factors (5\u0026ndash;7) .The most common cause is stones leading to squamous metaplasia, which was found in the previous kidney specimen that was removed from the patient two years ago. Squamous metaplasia considered by some authors as precancerous lesion, occurs more in the lower tract unlike the upper tract, and requires strict follow up (5,8). The clinical presentation of the disease includes no characteristic symptoms and signs, making it very difficult to diagnose as in this case the diagnosis was difficult, all the signs were making the diagnosis directed toward infection or retro-peritoneal abscess also the CT guided biopsy was not conclusive, until exploration was done (9). Pain, hematuria, local swelling of the loin and fistula formation or skin sinus as in our patient are symptoms that may occur in advanced disease (5,7,10). The treatment is radical surgery, due to the rarity of the cases the conclusive decision of applying radiotherapy or chemotherapy either in advanced or early cases, preoperatively or postoperatively, can\u0026rsquo;t be taken (10\u0026ndash;12) .To achieve similar outcome as transitional cell carcinoma the diagnosis must be early, as the main problem with this variant is its delayed diagnosis either according to the clinical picture or to radiological imaging (13).\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA male patient 47 years hypertension, on regular dialysis for eleven years due to ESRD , no other comorbidity were found beside history of a lower urinary tract surgery 17 years ago and a left sub-capsular nephrectomy 2019 at our department because he was complaining of persistent pyuria per urethera . After two years he presented with left loin pain and swelling that kept increasing in size and then eventually a skin sinus developed. MRI was done and showed a large lobulated mass at site of renal bed infiltrating the psoas muscle and lateral wall muscle measuring 14.5*7.5 cm with restricted diffusion. After reviewing his old biopsy it showed squamous metaplasia of the pelvicalyceal system and chronic glomerulonephritis. A Ct guided biopsy was done revealing areas of hyperplastic squamous epithelium, strips of chronic inflammatory cellular infiltrate \u0026amp; the cells showed prominent nucleoli with occasional mitosis and extensive keratinization. His labs were within normal serum creatinine was five, hemoglobin was ten. Urgent salvage surgery was performed. A chevron incision was done, adhesiolysis and dissection of massive peritoneal and colonic adhesion until the retroperitoneal space is reached. A fungating mass is found infiltrating most of the posterior abdominal wall muscles and the rib, it was found to infiltrate part of omentum. Excision of the mass and most of the necrotic tissue, closure was done in layers despite the difficulty we faced due to the extensive loss in tissue architecture resulting from extensive infiltration of the tumor. The patient had a smooth postoperative recovery and drain was removed after five days, the wound showed some discharge which was trivial. He was discharged after 9 days. He was presented in the follow up after three month with satisfactory performance and a good wound healing. His biopsy showed moderately differentiated squamous cell carcinoma.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSquamous cell carcinoma of renal pelvis is rare and highly aggressive. It has a high recurrence rate and low mean survival rate. Best treated by surgery. Squamous metaplasia should not be neglected . Stones, infection should be managed as early as possible with prevention of their recurrence. Nephrectomy in case of complicated renal disease should be radical. Regular follow up cystoscopy is required.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eESRD \u0026ndash;End Stage Renal Disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMRI-Magnetic Resonance Imaging.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCT- Computed tomography.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. Brits NF, Bulane S, Wadee R. Primary squamous cell carcinoma of the kidney: a case report and review of the literature. African Journal of Urology. 2020 Dec 3;26(1):79.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Bhaijee F. Squamous cell carcinoma of the renal pelvis. Annals of Diagnostic Pathology. 2012 Apr;16(2):124\u0026ndash;7.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Tickoo SK, dePeralta-Venturina MN, Harik LR, Worcester HD, Salama ME, Young AN, et al. Spectrum of Epithelial Neoplasms in End-Stage Renal Disease: An Experience From 66 TumorBearing Kidneys With Emphasis on Histologic Patterns Distinct From Those in Sporadic Adult Renal Neoplasia. American Journal of Surgical Pathology. 2006 Feb;30(2):141\u0026ndash;53.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Nakanishi Y, Koga F, Fukushima H, Motoi T, Tobisu K. Renal Cell Carcinoma in EndStage Renal Disease [Internet]. Updates in Hemodialysis. IntechOpen; 2015 [cited 2021 Oct 7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5. Chang T-H, Tseng J-S. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature. Open Med (Wars). 2021 Jan 12;16(1):128\u0026ndash;33.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6. Genega EM, Porter CR. Urothelial Neoplasms of the Kidney and Ureter. Pathology Patterns Reviews. 2002 Jun 1;117(suppl_1):S36\u0026ndash;48.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7. Sun X, Li Y. Incidental squamous cell carcinoma of renal pelvis presenting as skin invasion: a case report. Journal of Medical Case Reports. 2020 Dec 15;14(1):244.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e8. Ganeshappa A, Krambeck A, Grignon DJ, Lingeman JE. Endoscopic Management of Keratinizing Desquamative Squamous Metaplasia of the Upper Tract: A Case Report and Review of the Literature. Journal of Endourology. 2009 Aug;23(8):1277\u0026ndash;9.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e9. Jiang P, Wang C, Chen S, Li J, Xiang J, Xie L. Primary renal squamous cell carcinoma mimicking the renal cyst: a case report and review of the recent literature. BMC Urology. 2015 Jul 23;15(1):69.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10. Ghosh P, Saha K. Primary Intraparenchymal Squamous Cell Carcinoma of the Kidney: A Rare and Unique Entity. Case Reports in Pathology. 2014 Jan 20;2014:e256813.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11. Martin JW, Carballido EM, Ahmed A, Farhan B, Dutta R, Smith C, et al. Squamous cell carcinoma of the urinary bladder: Systematic review of clinical characteristics and therapeutic approaches. Arab Journal of Urology. 2016 Sep;14(3):183\u0026ndash;91.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12. Hosseinzadeh M, Mohammadzadeh S. Primary Pure Squamous Cell Carcinoma of Kidney Associated with Multiple Stag Horn Stones. Int Med Case Rep J. 2020;13:261\u0026ndash;3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e13. Sahoo TK, Das SK, Mishra C, Dhal I, Nayak R, Ali I, et al. Squamous Cell Carcinoma of Kidney and Its Prognosis: A Case Report and Review of the Literature. Case Reports in Urology. 2015;2015:1\u0026ndash;3.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e-Ethics approval and consent to participate : number is not required by our faculty of medicine laws\u003cbr\u003e-Consent for publication : obtained from the patient prior to the intervention\u003cbr\u003e-Availability of data and material : \u0026nbsp;available\u003cbr\u003e-Competing interests : NO\u003cbr\u003e-Funding : NO\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e-Authors\u0026apos; contributions : AM wrote the manuscript , MA is the operator and reviewed the manuscript.\u003cbr\u003e-Acknowledgements :\u0026nbsp;NO\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e-Authors\u0026apos; information (optional): obtained\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ESRD, rare, recurrent, surgery, salvage","lastPublishedDoi":"10.21203/rs.3.rs-1385406/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1385406/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cu\u003eBackground :\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\u003cp\u003eRenal cell carcinoma with all its variants represent more than ninety percent, the remaining ten percent is divided on urothelial tumors, sarcomas and metastasis from other organs. Squamous cell carcinoma of the renal pelvis is mentioned very few due to its rarity. Until now there is no guideline for managing it unlike transitional cell carcinoma. Our case is very rare, one or two case all over the world has been reported to our knowledge, also the treatment plan which was salvage surgery was very successful. \u003c/p\u003e\u003cp\u003e\u003cem\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u003cu\u003eCase\u003c/u\u003e\u003c/em\u003e \u003cem\u003e\u003cu\u003epresentation\u003c/u\u003e\u003c/em\u003e:\u003c/p\u003e\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003eThis article will discuss a male patient who developed squamous cell carcinoma in the renal bed after nephrectomy, managed with excellent outcome in Assiut university hospital. After 8 month the patient show good and excellent performance. \u003c/p\u003e\u003cp\u003e\u003cem\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u003cu\u003eConclusions\u003c/u\u003e\u003c/em\u003e :\u003c/p\u003e\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003eThe general rule of this type of malignancy is that it is resistant to both chemo and radiotherapy with good outcome to surgery if early intervention was done. Our case could provide a beacon for similar cases.\u003c/p\u003e","manuscriptTitle":"Cutaneous fistula, a rare presentation of squamous cell carcinoma of the renal pelvis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-04-05 17:57:02","doi":"10.21203/rs.3.rs-1385406/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c358d732-fecb-4de7-a86d-27f42f4df55d","owner":[],"postedDate":"April 5th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-04-05T17:57:02+00:00","versionOfRecord":[],"versionCreatedAt":"2022-04-05 17:57:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1385406","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1385406","identity":"rs-1385406","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}