Long standing calculi and renal malignancy

Objective: The objective of our study was to document the histological type and morphology of neoplastic lesion found concomitantly with renal calculi. Background: Renal calculi is one of the most common urological condition. Chronic irritation induced by predisposing factors superimposed by infection is believed to induce squamous metaplasia. Subsequent development of leucoplakia and neoplasia in the urothelium stimulated RCC. The dismal prognosis of renal malignancy in patients with long standing calculi compelled us to study the clinicopathological presentation. Methods: In our series, we retrospectively examined records of about the nephrectomies done for long standing calculi with nonfunctional kidney in Pravara Rural Hospital, Loni during a span of 3 years from January 2018 to March 2021. Results: We analysed 30 cases of nephrectomies considering pre-op factors like age, gender, laterality of disease, radiological investigations ,method of determination of non functional kidney(USG,CT-IVP,DTPA), signs and symptoms of distant metastasis, type of nephrectomy and histopathological report of the nephrectomy specimens in patients with long standing renal calculi. 62.5% were males and 37.5% females. Right side malignancy was reported in 75% patients where as left side reported in 25% patients. 75 % patients underwent Simple nephrectomy whereas only 25% patients underwent radical nephrectomy for the same. Histopathological study 62.5% of the patients had squamous cell carcinoma 25 % of the patients had clear cell carcinoma,12.5% had urothelial Carcinoma with squamoid differentiation. Lymphovascular invasion was found in 37.5% of the patients. Conclusions: Our study has shown that malignancies associated with stone disease have insidious onset of clinical symptoms and there is a fair incidence of squamous malignancies. The possible way to improve prognosis is early diagnosis by screening patients of long standing urolithiasis with a CT scan in order to detect the associated malignancies. So the planning of appropriate early surgical intervention can be done and to improve the prognosis .