Primary Squamous Cell Carcinoma in a Transplanted Kidney: A Unique Case Highlighting Challenges in Diagnosis and Management.

Kidney transplantation is the preferred treatment for end-stage renal disease, but it involves risks, including an increased chance of malignancy due to several variables. We present a rare case of primary renal squamous cell carcinoma (SCC) in an allograft kidney. This patient, who had a renal transplant one year prior, presented with oliguria, elevated creatinine, and asthenia. Imaging done raised suspicion of a mass-like structure and biopsy subsequently done confirmed a primary SCC in the transplanted kidney, leading to a total nephrectomy and hemodialysis initiation. This case highlights the different cancer risks faced by transplant recipients, particularly due to immunosuppressive medications. We discuss emerging alternatives in immunosuppression that may mitigate these risks. Given the rarity of primary SCC in allografts, determining the cancer's origin whether primary or metastatic is critical for effective management since this distinction could shape future approaches to managing allograft malignancies. We also emphasize the importance of establishing imaging and monitoring guidelines and how combining imaging with serum and urine studies may enhance cancer surveillance, aiding in long-term graft health and transplant longevity.