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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 877-879
Cystic nephroma masquerading as hydatid cyst of the kidney


1 Department of Urology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Abrol N, Gupta N, Arava S, Ray R. Cystic nephroma masquerading as hydatid cyst of the kidney. Indian J Pathol Microbiol 2010;53:877-9

How to cite this URL:
Abrol N, Gupta N, Arava S, Ray R. Cystic nephroma masquerading as hydatid cyst of the kidney. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Sep 23];53:877-9. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/877/72029


Sir,

Cystic nephroma is a rare, benign, and cystic lesion of the kidney. According to the "WHO classification of the renal neoplasms," it is grouped along with the mixed epithelial-stromal tumors of the kidney. [1] While histological features of cystic nephroma are well described, radiologic similarities with other cystic lesions of the kidney may cause confusion in diagnosis.

A 27-year-old female presented with left loin pain and fever. Abdominal ultrasonography showed an irregular anechoic area with internal septae in the right lobe of the liver and upper pole of the left kidney. A computed tomographic (CT) scan showed well-defined fluid attenuating round lesion with multiple daughter cysts in segments five and eight of the liver. A similar-looking multi-septated cystic mass was seen in the upper pole of the left kidney [Figure 1]. There was no solid component or calcification. Diagnosis of hydatid cyst of the liver and left kidney was made. Surgery for liver cyst was performed first. Diagnosis of liver hydatid cyst was established intraoperatively and the marsupialization procedure was carried out. After recovery, she was planned for left renal cyst surgery. Intraoperatively, gross appearance of renal cyst was not typical of hydatid [Figure 2]a. There was no pericyst. We decided to take a frozen section from the wall of the cyst. Partial nephrectomy was performed once the frozen section confirmed it as cystic nephroma. The cut-section of the specimen showed multiple non-communicating cystic areas of varying sizes lined with thin septae, without any solid component, and containing clear to straw-colored fluid [Figure 2]b. Histopathologic examination showed multi-locular cysts [Figure 3] lined with cuboidal to columnar epithelium [Figure 3] inset containing eosinophilic secretions in the lumen and normal renal parenchyma at the periphery.
Figure 1: Axial computed tomography showing multiseptate cystic lesion in the right lobe of the liver and upper pole of the left kidney

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Figure 2: (a) Gross specimen and (b) cut-section of the kidney cyst showing multiple, non-communicating cysts lined with thin septae and no solid component

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Figure 3: Multilocular cyst. Inset showing magnified view of cyst lining from site marked by black circle

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The first case of cystic nephroma was reported by Edmunds [2] in 1892 as cystic adenoma of the kidney. Less than 200 cases have been reported till date in the international literature. [3] To the best of our knowledge, its presence with hydatid cyst of the liver has not been reported earlier. Cystic nephroma is a characteristic renal lesion with a bimodal age distribution and a benign clinical course. It primarily occurs in the first 2-3 years of life and again, primarily, in the fourth and fifth decades. [4] A male predominance is observed in children and a female predominance in adults. [4] Children tend to present with an asymptomatic abdominal mass detected on routine physical examination, whereas symptomatic presentation is more common in adults. [4]

In gross appearance, these lesions are well circumscribed, encapsulated and consist of multiple, non-communicating, fluid-filled spaces partitioned by septae. Depending on the cyst size, the smaller cysts have cuboidal to low columnar tubular epithelium and the larger cysts have a flattened epithelium. The lining epithelium of the cysts does not show any abnormal mitosis.

Presence of hydatid cyst in the liver, younger age of our patient and its radiologic resemblance to liver cyst made us diagnose the kidney lesion as hydatid. Definitive diagnosis of renal cystic lesions may be difficult on the basis of imaging alone. In doubtful cases, a frozen section helps plan surgical management, although final diagnosis can only be made on histopathologic examination of the resected specimen.

 
   References Top

1.Bonsib SM. Cystic nephroma. Mixed epithelial and stromal tumor. In: Eble JN, Sauter G, Epstein JL, Sesterhenn IA, editors. Pathology and genetics of tumors of the urinary system and male genital organs. WHO classification of tumours. Lyon: IARC Press; 2004. p. 76.  Back to cited text no. 1
    
2.Edmunds W. Cystic adenoma of the kidney. Trans Pathol Soc Lond 1892;43:89-90.  Back to cited text no. 2
    
3.Konstantinos S, Konstantinos P, Gerasimos K, Stefanos D. Cystic nephroma: A case report and review of the literature. Cases J 2008;1:267.  Back to cited text no. 3
    
4.Castillo OA, Boyle ET, Kramer SA. Multilocular cysts of kidney: A study of 29 patients and review of literature. Urology 1991;37:156-62.  Back to cited text no. 4
    

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Correspondence Address:
Nitin Abrol
Department of Urology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72029

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
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[Pubmed] | [DOI]



 

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