PRIMARY SQUAMOUS-CELL CARCINOMA OF THE KIDNEY AS A SEQUEL OF RENAL CALCULI

H. GIDEON WELLS
1922 Archives of Surgery  
An unusual case of renal tumor that has recently come under my observation carries so much evidence as to the relation of trauma and tumor formation, as well as to other problems of pathology, that it seems worthy of publication. It concerns a case of primary squamous\x=req-\ cell carcinoma of the kidney, arising as a sequel of renal calculi. REPORT OF CASE History.\p=m-\A man, aged 57, a tailor, entered the Cook County Hospital, June 13, 1921, two weeks before his death, complaining of
more » ... plaining of abdominal pains of six months' duration, associated with frequent burning micturition, and a loss of about 30 pounds (13.6 kg.) in weight. There was no history of pain characteristic of renal colic, although he said that he had suffered from pain over the bladder when he was 20 years old; beyond this there had been no previous illnesses. Venereal infection and alcoholism were denied. He had never noticed blood in the urine, although it was turbid. Examination.\p=m-\Theonly positive findings on examination were these. On the right side of the abdomen there was a tender mass about the size of a coconut, extending from the costal border to 5 cm. above the umbilicus. Roentgen-ray examination revealed the presence of multiple stones in an enlarged right kidney. The cystoscope showed the vesical mucosa congested without ulcération. Ureteral catheterization showed that the right kidney did not function. With 1 c.c. of phenolsulphonephthalein, injected intravenously, the dye showed in the urine from the left ureter in six minutes, but none . appeared from the right side in thirty minutes. The phenolsulphonephthalein test, intravenously, yielded 30 per cent, in the first half hour and 20 per cent, more in the second half hour from the left side. The urine contained albumin, pus, and blood, but few casts. A 25 per cent, solution of sodium bromid was injected by the ureteral catheters, the right side taking 20 c.c, the left 10 c.c. Roentgenograms then revealed, on the left side, a somewhat enlarged left kidney with slightly enlarged multiple calices : the right kidnev showed a pelvis of irregular shape, apparently with escape of the injected fluid into the substance of the diseased kidney. The stones seemed to be not only in the kidney but also in the surrounding soft tissues. Blood analysis gave the following figures : total nonprotein nitrogen, 39.27 mg. per hundred ex.; urea nitrogen, 18.4 mg. ; uric acid nitrogen, 2.27; creatinin nitrogen, 1.47. The leukocyte count was 11,800. Following the ureteral catheterization the patient had a chill, and he continued to grow progressively weaker, usually with a subnormal temperature.
doi:10.1001/archsurg.1922.01110140144007 fatcat:tzbhun6nobgi5puiqm44estfge