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Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 274-275
Mucinous cystadenoma of the kidney


1 Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
2 Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

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How to cite this article:
Kumar B, Agarwal RK, Upadhyay P. Mucinous cystadenoma of the kidney. Indian J Pathol Microbiol 2009;52:274-5

How to cite this URL:
Kumar B, Agarwal RK, Upadhyay P. Mucinous cystadenoma of the kidney. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Sep 20];52:274-5. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/274/48945


Sir,

Mucinous cystadenoma is an extremely rare tumor of the kidney. Since 1929, only five cases have been recorded in the English literature. [1],[2],[3],[4],[5] We report the present case of the largest and multilocular mucinous cystadenoma among the reported cases, involving the entire kidney, not only because of its extreme rarity but also because of the fact that it clinically and radiologically mimicked hydronephrosis due to obstructive uropathy caused by renal calculi.

A 63-year-old male presented with complaints of burning micturition and lump on the right side of his abdomen for 30 days. Ultrasonography and computerized tomography revealed cystic enlargement of the right kidney with presence of multiple calculi in the dilated renal pelvis [Figure 1]. Intravenous pyelography showed a non-functional right-sided kidney. Routine laboratory investigations were normal except for the presence of neutrophlilic leucocytosis. The patient underwent right-sided radical nephrectomy with the clinical diagnosis of right-sided non-functional kidney associated with marked hydronephrosis.

The whole kidney, including the renal pelvis, was cystically dilated and measured 21cm × 15cm × 10cm. The outer surface was smooth and bosselated. The segment of ureter measured 6cm × 0.5cm. The cut surface showed a multilocular cyst filled with mucinous material and the cysts had direct communication with the renal pelvis. The renal cortex could not be distinguished grossly. The cyst wall was thin, smooth and measured 0.1-0.3cm in thickness. Neither papillary projection nor solid area was present [Figure 2]. One large stag-horn calculus and multiple small brownish black-colored stones were identified inside the renal pelvis. Representative sections examined from the cysts showed a fibrous wall lined by single-layered mucous secreting tall, columnar epithelium along with foci of chronic inflammatory cell infiltrate [Figure 3], lymphoid follicles, atrophic tubules, tubules with colloid cast and occasional glomeruli. The sections from the pelvis and the ureter revealed a similar lining epithelium [Figure 4].

The lesion closely mimicked the mucinous cystadenoma of the ovary, both grossly as well as microscopically, and a diagnosis of the mucinous cystadenoma of the right kidney with associated chronic pyelonephritis and nephrolithiasis was made.

Three of the five reported cases were discovered in the normal kidney. [3],[4],[5] The other two cases were associated with horseshoe kidney and were postulated to arise from the sequestered segment of the renal pelvic epithelium in the renal parenchyma of an anomalous kidney. [1],[2] The histogenesis of the cystic mucinous epithelial tumor in the normal kidney has been ascribed to mucinous metaplasia associated with urolithiasis and pyelonephritis. It has been speculated that multipotent transitional epithelium of the renal pelvis is capable of undergoing metaplastic transformation when subjected to chronic irritation from the calculi, hydronephrosis or pyelonephritis. [1],[5]

In conclusion, an abdominal mass with clinical features suggestive of urinary tract infection should be investigated for renal calculi, pyelonephritis, cyst formation and tumor growth. Functional capacity should be evaluated by intravenous pyelography. If a cyst is found, it should be aspirated under the guidance of an ultrasonogram and subjected to microscopic examination. If the findings are suggestive of malignancy or non-functional kidney, radical or total nephrectomy may be resorted to. Other benign localized renal cyst is treated by partial nephrectomy. Histopathological examination of the nephrectomy specimen is mandatory for definite diagnosis.

 
   References Top

1.Akan H, Dalva I, Yildiz O, Kutluay L, Gundogdu S, Gungen Y. Mucinous cystadenoma mimicking simple renal parenchymal cyst in a horseshoe kidney. Int J Urol 2005;12:493-6.  Back to cited text no. 1    
2.Ross DG, D'Amato NA. Papillary mucinous cystadenoma of ­probable renal pelvic origin in a horseshoe kidney. Arch Pathol Lab Med 1985;109:954-5.  Back to cited text no. 2  [PUBMED]  
3.Takashi M, Matsuyama M, Furuhashi K, Kodama Y, Shinzato M, Shamoto M, et al . Composite tumor of mucinous cystadenoma and somatostatinoma of the kidney. Int J Urol 2003;10:603-6.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Toyoda H, Mabuchi T, Fukuda K. Mucinous cystadenoma with malignant transformation arising in the renal pelvis. Pathol Int 1997;47:174-8.  Back to cited text no. 4  [PUBMED]  
5.Mardi K, Sharma J, Mahajan P. Mucinous cystadenoma of the renal pelvis with malignant transformation: A case report. Indian J Pathol Microbiol 2006;49:595-6.  Back to cited text no. 5  [PUBMED]  

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Correspondence Address:
Bipin Kumar
Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48945

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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