Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2020  |  Volume : 63  |  Issue : 3  |  Page : 499--500

Hydatid cyst of kidney in a 60-year-old female: A rare case report


Varughese P George, Kathirvelu Shanmugasamy, Sowmya Srinivasan, Anandraj V Krishnamurthy, A T. M Venkat Raghavan 
 Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India

Correspondence Address:
Sowmya Srinivasan
Professor and Head, Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pillaiyarkuppam, Puducherry - 607 402
India




How to cite this article:
George VP, Shanmugasamy K, Srinivasan S, Krishnamurthy AV, Venkat Raghavan A T. Hydatid cyst of kidney in a 60-year-old female: A rare case report.Indian J Pathol Microbiol 2020;63:499-500


How to cite this URL:
George VP, Shanmugasamy K, Srinivasan S, Krishnamurthy AV, Venkat Raghavan A T. Hydatid cyst of kidney in a 60-year-old female: A rare case report. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Nov 24 ];63:499-500
Available from: https://www.ijpmonline.org/text.asp?2020/63/3/499/291661


Full Text



Dear Editor,

Hydatid disease is an uncommon condition that poses to be a major health issue across the world. It is usually seen in people living in endemic areas tending to animal husbandry.[1] It is caused by the tapeworm Echinococcus granulosus which is transmitted to dogs (the definitive host) via the fecal-oral route. Humans (the intermediate host) get infected upon ingestion of the parasitic eggs that are released into the fecal matter of infected dogs. In most cases, the liver is the most commonly involved site, followed by the lungs. However, primary renal hydatid cysts are very uncommon. It is postulated that the cysts reach the kidneys via retroperitoneal lymphatics from the portal venous system.[2] Normally, it takes many years for the hydatid cyst to grow into a significant size, thus bringing about a delay in the appearance of clinical manifestations. The most common clinical manifestations are abdominal pain with gross hydaturia.[3] Since complex renal cysts are known to simulate neoplasms, the radiologic studies are often inconclusive in most cases. Hence, a confirmatory diagnosis is critical for treatment.

A 60-year-old lady presented with complaints of right loin pain for duration of 3 years with history of intermittent febrile episodes. She gave history of having a pet dog at home. Clinical examination revealed a palpable tender mass extending into the right hypochondrium, epigastrium, umbilical and right lumbar regions. Ultrasonography of abdomen revealed right multicystic dysplastic kidney with solid components [Figure 1]. A computerized tomography (CT) scan of abdomen also showed similar findings. A radical nephrectomy was performed and the specimen was sent for histopathological evaluation.{Figure 1}

Gross examination of specimen revealed a multi-cystic bosselated renal mass measuring 13 × 10 × 4 cm with attached ureter measuring 3 cm in length. The external surface showed multiple cysts filled with fluid, covered with purulent exudate. The cut section revealed a cystic lesion at the upper pole, measuring 7 × 6 cm with thinned out cortex and medulla with distorted pelvi-calyceal system [Figure 2]. Four lymph nodes were also identified. The Hematoxylin and Eosin (H and E) stained tissue sections revealed a cyst wall with features of calcification; daughter cysts with hyalinized lamellated membrane [Figure 3]; lymph nodes with features of reactive hyperplasia and ureter showing thickened wall with lymphocytic and eosinophilic infiltrates. The features were consistent with a diagnosis of right-sided renal hydatid cyst with features of chronic pyelonephritis.{Figure 2}{Figure 3}

Similar findings were observed in a retrospective 33-year review of 178 renal hydatid cysts in Tunisia, in which patients ranged in age from 6 to 84 years, with a mean age of 40.6 years and females were affected more than males owing to prolonged exposure to domestic animals at home.[4]

The unusual presentation of renal hydatid cyst needs attention since it can mimic cystic renal cell carcinoma on imaging.[5] However, a meticulous histopathological examination brings out the final diagnosis which may astound clinicians many a time.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Choi H, Park JY, Kim J-H, Moon DG, Lee J-G, Bae JH. Primary renal hydatid cyst: Mis-interpretation as a renal malignancy. Korean J Parasitol 2014;52:295-8.
3Shukla A, Garge S, Verma P. A case of large renal hydatid cyst. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab 2011;22:538-40.
4Zmerli S, Ayed M, Horchani A, Chami I, El Ouakdi M, Ben Slama MR. Hydatid cyst of the kidney: Diagnosis and treatment. World J Surg 2001;25:68-74.
5Bhat GS, Burude VA, Hegde SD, Tembadamani VS. Isolated renal hydatid cyst masquerading as cystic renal cell carcinoma: A case report. J Clin Diagn Res JCDR 2015;9:7.