Squamous cell carcinoma of the renal pelvis with stones and inferior vena cava infiltration. Case report

We report a rare case of a 50 year old man with renal squamous cell carcinoma (SCC) who first came to our attention with renal colic and fever not responding to antibiotic or analgesic treatment. He had a long history of kidney stones, but had not undergone any imaging in the last 5 years. Physical examination revealed tenderness and a palpable mass in the right flank and lumbar region. A whole body CT scan was performed, revealing an 11 cm mass in the right kidney infiltrating the inferior vena cava. There were areas of calcification within the mass and multiple stones within the renal pelvis. The tumor was considered unsuitable for resection according to radiological and clinical criteria. The mass was biopsied percutaneously under CT guidance and histological examination revealed squamous cell carcinoma of the renal pelvis. The patient was treated with neoadjuvant chemotherapy and embolization of the renal artery. He died one month after diagnosis. To our knowledge this is the second reported case in the world of renal SCC infiltrating the inferior vena cava and with kidney stones.

The spatial dimension of cycle logistics

US Cycle logistics is emerging as a promising alternative in urban freight transport. Compared to fossil fuelled vans, the use of cycles for delivering goods within urban areas offers advantages in terms of environmental friendliness, economic efficiency, flexibility, and liveability of urban neighbourhood. At the same time, cycle logistics has to face limits in terms of weight and volume of goods that can be delivered, distances that can be covered, and spatial urban structures that can be served. This latter issue has till now received less attention in the scientific literature: it is generally recognized that cycle logistics performs at its best in inner urban areas, but no systematic study has been realized to identify specific spatial requisites for the effectiveness of cycle logistics. This paper provides a brief review of the main issues that emerge from the literature over cycle logistics, and contributes to stimulate the debate over the spatial dimension of cycle logistics: it presents a classification of cycle logistics schemes, on the basis of their integration with other urban logistic facilities and of the spatial structure of delivery operations. A three-level classification is proposed, depending on the type of goods consolidation: only distribution without consolidation, consolidation in a fixed urban consolidation centre, or consolidation in a mobile depot; for each level, operational examples and case studies are provided. This systematizing typology could support both public and private operators in decisions about the organization of cycle logistics facilities, such as the location of urban consolidation centres or the composition of cycle fleets.