Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Cell Carcinoma: A Case Report

Abstract

A 48-year-old lady presented to our outpatient department with a vague pain in the abdomen weight loss since last six months. The lady appeared moderately built but poorly nourished without any other positive findings on clinical examination. Her blood and biochemical examination gave no clue to the diagnosis as there was only raised Erythrocyte Sedimentation Rate (ESR). Abdominal ultrasound detected a left upper pole mixed density lesion in the kidney [ With this investigation background, we suspected a cystic RCC and planned a trans abdominal approach. On entering the retroperitoneum we found a cystic mass in upper pole of the left kidney with no lymph nodes. The boundaries were defined, vessels were isolated and then renal capsule was opened at the point where the mass abutted with normal lower pole. Rest of the abdomen was isolated by sterile mops so that any inadvertent leakage doesn't lead to abdominal seedling. Upper pole nephrectomy was planned and dissection was carried out. The cyst opened at the lateral most part while taking the specimen out of the abdomen, when we found daughter cysts coming out to our surprise [Table /Fig-4 Incidentally detected renal cysts are always a diagnostic challenge especially when they present with equivocal features on imaging. Proper diagnosis is of paramount importance as it affects the treatment decisions. Septal and nodular enhancement on computed tomography (CT) is the strongest predictor of malignant process. A multilocular cystic lesion with heterogeneity on CT goes in favour of hydatid disease. Though the treatment in both these cases is surgical excision, a more careful study of image may ease the treatment planning process much more. We report a case in middle aged lady who presented with vague abdominal pain with loss of weight, who was found to have a cystic mass in the upper pole of the left kidney on imaging turned out to be hydatid cyst though the radiological features were in favour of cystic renal cell carcinonoma.

A simple score for predicting urinary fistula in patients with renal hydatid cysts

“…The second element that orients toward the rupture of a hydatid cyst into the urinary tract relies on blood biology. Hypereosinophilia is noted in 20–50% of the cases and is particularly increased in opened cyst [ 18 ]. In our series, hypereosinophilia was noted in 37.7% of the cases.…”

Isolated large renal hydatid cyst treated by laparoscopic nephrectomy

“…The most common clinical finding is a palpable mass. Patients with renal hydatid cystic disease usually present vague pain in the flank region [7]. The cyst's may rupture into the collecting system causing hydatiduria, which is a pathognomonic sign of renal hydatidosis.…”