small cell carcinoma ( scc ) frequently originates from lung , which constitutes approximately 10 - 20% of pulmonary malignant neoplasm . extrapulmonary scc ( epscc ) is very rare , constituting only about 5% of the total scc , which is generally known to be more fatal than pulmonary scc . among epscc , the first case of primary renal scc was described by capella c in 1984 , and to our knowledge , there are only 34 such cases reported in the english literatures . so far , there has been no cases on renal transplant recipients ( rtrs ) ' own kidney primary scc reported . so we believe that this is the first case report on renal primary scc of rtr . a 68-year - old chinese lady was presented with right renal mass after routine ultrasound examination of the abdomen . she had no obvious complaint and no history of ( h / o ) hematuria , loin pain , and fever . she received tacrolimus ( fk506 ) , mycophenolate mofetil ( mmf ) , and prednisone as immunosuppressive agent . on physical examination , patient 's general condition was fair , she was nonanemic , nonicteric , and no sign of peripheral lymphadenopathy was noted . ultrasonography ( usg ) of the abdomen revealed a mass of size 4  3 cm in the right kidney and several other smaller masses behind the inferior venacava ( ivc ) , the biggest one measuring 3.3  2.0 cm in size . computer tomography ( ct ) of the abdomen showed right renal mass ( ct value 42 hu ) on slight enhancement and ( ct value 55 hu ) on contrast enhancement , and right hydronephrosis , multiple enlarged abdominal lymph nodes , left shrunken kidney , and normal allograft in the pelvis [ figure 1 ] . mri of the abdomen further showed a right renal mass of size 4.3  4.6  6 cm with high t1- and moderate t2-weighted image . contrast - enhanced ct scans : right renal mass ( ct value 42 hu ) with slight enhancement ( ct value 55 hu ) on contrast enhancement , right hydronephrosis ; multiple enlarged abdominal lymph nodes ( with arrow head ) ; and left shrunken kidney after thorough preoperative preparation , resection of bilateral native kidneys with whole length of ureters and small cuffs of bladder was done . the tumor was 4  3 cm in size , located in the middle and lower pole of the right kidney . the resected neoplasm had pseudocapsule , and the dissected section was dark red in color . multiple enlarged lymph nodes were also seen in the para - aortic region and behind the ivc ; the largest one measuring about 3  2 cm in size . the postoperative period was uneventful and the patient got discharged on the 15 day . histopathological report showed mixed scc of the right kidney [ figure 2 ] ( scc combined with little transitional cell carcinoma).the retroperitoneal lymph nodes ( 3/6 ) also showed tumor metastasis with same pathology as that of the right kidney . immunohistochemistry results were as follows : chromogranin ( cga)(+ ) , vimentin(+ ) , cd56(+ ) , cd99(+ ) , ck(little cell + ) , ema , cd10 , ck7 , ck20 , synaptophysin ( syn ) , and bcl-2.generally , cga and syn with both positive or just one test positive can be considered as scc . microscopic picture ( original magnification , 40 ) platinum - based adjuvant chemotherapy ( cisplatin combined with gemcitabine ) was given postoperatively . during follow- up ( till 1 year after the surgery ) , the patient was found to be in good health with well - functioning transplanted kidney containing serum creatinine in the range of 90 to 100 umol / l . due to its extreme rarity , it is very difficult to devise a guideline for renal scc treatment , and till date , the therapeutic strategy for treating renal scc is still a challenge for urologists . the epscc resembles primary pulmonary scc in many respects , such as histological characters , aggressive nature , high propensity for distant dissemination , etc . thus , many authors refer to pulmonary scc to create its therapeutic strategy . in the above - mentioned literature , maihail et al . , reviewed 22 patients of scc that originated from kidney or renal pelvis , and who had received surgery combined with systemic adjuvant chemotherapy ; the median survival of platinum - containing regimen group was 20 months while it was only 8 months in group not receiving platinum . hence the author indicates that the primary therapeutic modality for renal scc is surgery combined with systemic chemotherapy . the platinum - based chemotherapy has been found responsible for tumor regression as well as patients ' prolonged survival . timothy r. asmis et al . , analysed 12 cases of urinary bladder scc and 10 cases of prostate scc . they found out that the prognosis of bladder scc was better than prostate scc , with median survival of 19.8 months vs 9.5 months . the increased incidence of malignancy in patients on immunosuppression following organ transplantation is well documented . some authors point out that the accrual risk of de novo malignancy following renal transplantation is approximately 100 times greater than the general population . thus , we believe that the etiology of the recipient ' own kidney scc may relate to immunosuppressive modality . this indicates that the surveillance for malignancy after transplantation should be strengthened in order to find it out in the earliest stage . in our case , we decided to resect the contra - lateral kidney , whole length of ureter , and small cuff of bladder as well , to prevent the recurrence of disease in contra - lateral kidney or renal pelvis . after histopathological confirmation of the renal scc , the platinum - based adjuvant chemotherapy was applied and the patient responded well to this therapy . however , there are also reports of prostate scc after renal transplantation , which had more fulminant progression than scc of other organs we believe that this is the first case of primary scc of rtrs ' own kidney .
small cell carcinoma ( scc ) originating from kidney is extremely rare . to date 
 , there has been no reported case of primary scc of renal transplant recipients ' ( rtrs ) ' own kidney . here , we report the first case of primary scc of rtrs ' own kidney . 
 resection of bilateral native kidneys , possessing whole length of ureters and small cuffs of bladder along with a neoplasm located in her right kidney , was performed on a 68-year - old female patient , five years after renal transplantation . 
 the immuno - histochemical result confirmed mixed scc of the right kidney ( scc combined with little transitional cell carcinoma ) . 
 postoperatively , platinum - based adjuvant chemotherapy ( cisplatin combined with gemcitabine ) was given , and the patient is still alive with well - functioning transplanted kidney .