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Spontaneous disappearance and successive reappearance of renal cyst
SPONTANEOUS REAPPEARANCE U. MUSIANI,
M.D.
U. VILLANI,
M.D.
DISAPPEARANCE
AND SUCCESSIVE
OF RENAL CYST
From the Division of Urology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
ABSTRACT-We report on a patient with a renal cyst which disappeared, later, and then two years later the cyst was reduced in volume.
Spontaneous disappearance of a renal cyst is rare. We report on a patient with a renal cyst that disappeared spontaneously and reappeared at a later date. Case Report This patient was a fifty-one-year-old woman who had a history of high temperatures with microscopic hematuria and albuminuria at age thirty-five. A urogram of the left kidney showed a parapyelic cyst which shifted the renal pelvis and lumbar ureter medially (Fig. 1A). One year later she concluded a normal pregnancy with a normal delivery. At age thirty-nine a urogram showed that the renal cyst had disappeared without any subjective symptoms, and both the kidney and upper urinary tract were shown to be normal (Fig. 1B). A third urogram ten years later showed the reappearance of the parapyelic cyst of the left kidney with the same characteristics found on the first examination (Fig. 1C). Two years later a urogram showed that the cyst was reduced in volume (Fig. 1D). Comment One explanation for the radiologic disappearance of the renal cyst is that it ruptured be-
366
reappeared
ten years
cause of a thin wall. Over the cystic endothelium both fibrous and smooth muscular layers can be very thin and in some may even be absent. The rupture of a cyst may be attributed to (1) increase of pressure within the cyst, and (2) increase in the endopyelic pressure. Normally, the pressure withinthe cyst is between 6 to 15 ml’ and between 1 to 32 mm Hg.2 In our experience with 11 cases we found pressures to be between 12 to 15 mm Hg.3 Trauma, hemorrhage, or infection can increase this pressure, as will contusions, most frequently resulting from trauma, or violent muscular strain, or coughing.4,5 Increases in endocalycopyelic pressure can be caused by stones,6.7 neurogenic bladder, or prostatic adenoma. The cystic liquid can leak into or enter either the calycopyelic cavities or the perirenal space. If the liquid enters the upper urinary tract, hematuria of one of various types can occur; and if it is microscopic hematuria, the patient will be asymptomatic. If the cystic liquid enters the perirenal space, the patient usually feels a sharp pain or a mass. A pyelogenic cyst or hydrocalyx would have visualized on the urogram. In our case the cyst may have ruptured during childbirth, and once the cyst reappeared it partially emptied at a later date without the patient aware of any
UROLOGY
i
OCTOBER
1984
/ VOLUME
XXIV, NUMBER
4
FIGURE1.
Urograms: (A) Urography November 2, 1964, shows parapyelic cyst of left kidney; (B) May 29, 1968, shows renal cyst disappeared; (C) February 9, 1976, shows reappearance of cyst ten year-s later: (D) October 14. 1977. cyst is reduced in volume.
strain. Because of the absence of painful symptomatology, we believe the liquid from the cyst must have been excreted without causing macroscopic hematuria. The disappearance, reappearance, and then diminution of the cyst volume could be explained by the presence of a thin spot on the wall of the cyst which could have ruptured with an increase in intracystic or endopyelic pressure and then spontaneously closed. Reggio Emilia, Ital] (DR. VILLANI)
UROLOCY
’ OCTOBER
1984
I VOLUME
XXIV. SUMBER
References 1. McLaughlin M, and Pfister G: Spontaneous rupture of renal cyst into the pyelocaliceal system, J Urol 113: 2 (1975). 2. Bjerle SR: Pressure measurement in renal cysts, J Clin Lab 27: 135 (1971). 3. Leoni S: Cisti sierose solitarie del rrne. Arch Ital Urol Nephrol 47: 397 (1979). 4. Steg A: Les affections kystiques due rein de I’adulte, Assoc Franc Ural 69 Session, Paris. .Octbber, 1975. 5. Doremieux 1. Naecele S. Masson I. and Bolla CK: La maladie de Wuriderlic comlivation des ky&n jereux. J Urol Nephrol 79: 512 (1973). 6. Durand 1~: Disparition spontanee d‘une image tumoral. ihid 75: 845 (1969). 7. Vacant A. Beurton J, and Cukier J: Effet d’une lithiase ureteral obstructive sur un kyste solitaire du rein. ihid 79: 43 (1973).
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367
M.D.
U. VILLANI,
M.D.
DISAPPEARANCE
AND SUCCESSIVE
OF RENAL CYST
From the Division of Urology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
ABSTRACT-We report on a patient with a renal cyst which disappeared, later, and then two years later the cyst was reduced in volume.
Spontaneous disappearance of a renal cyst is rare. We report on a patient with a renal cyst that disappeared spontaneously and reappeared at a later date. Case Report This patient was a fifty-one-year-old woman who had a history of high temperatures with microscopic hematuria and albuminuria at age thirty-five. A urogram of the left kidney showed a parapyelic cyst which shifted the renal pelvis and lumbar ureter medially (Fig. 1A). One year later she concluded a normal pregnancy with a normal delivery. At age thirty-nine a urogram showed that the renal cyst had disappeared without any subjective symptoms, and both the kidney and upper urinary tract were shown to be normal (Fig. 1B). A third urogram ten years later showed the reappearance of the parapyelic cyst of the left kidney with the same characteristics found on the first examination (Fig. 1C). Two years later a urogram showed that the cyst was reduced in volume (Fig. 1D). Comment One explanation for the radiologic disappearance of the renal cyst is that it ruptured be-
366
reappeared
ten years
cause of a thin wall. Over the cystic endothelium both fibrous and smooth muscular layers can be very thin and in some may even be absent. The rupture of a cyst may be attributed to (1) increase of pressure within the cyst, and (2) increase in the endopyelic pressure. Normally, the pressure withinthe cyst is between 6 to 15 ml’ and between 1 to 32 mm Hg.2 In our experience with 11 cases we found pressures to be between 12 to 15 mm Hg.3 Trauma, hemorrhage, or infection can increase this pressure, as will contusions, most frequently resulting from trauma, or violent muscular strain, or coughing.4,5 Increases in endocalycopyelic pressure can be caused by stones,6.7 neurogenic bladder, or prostatic adenoma. The cystic liquid can leak into or enter either the calycopyelic cavities or the perirenal space. If the liquid enters the upper urinary tract, hematuria of one of various types can occur; and if it is microscopic hematuria, the patient will be asymptomatic. If the cystic liquid enters the perirenal space, the patient usually feels a sharp pain or a mass. A pyelogenic cyst or hydrocalyx would have visualized on the urogram. In our case the cyst may have ruptured during childbirth, and once the cyst reappeared it partially emptied at a later date without the patient aware of any
UROLOGY
i
OCTOBER
1984
/ VOLUME
XXIV, NUMBER
4
FIGURE1.
Urograms: (A) Urography November 2, 1964, shows parapyelic cyst of left kidney; (B) May 29, 1968, shows renal cyst disappeared; (C) February 9, 1976, shows reappearance of cyst ten year-s later: (D) October 14. 1977. cyst is reduced in volume.
strain. Because of the absence of painful symptomatology, we believe the liquid from the cyst must have been excreted without causing macroscopic hematuria. The disappearance, reappearance, and then diminution of the cyst volume could be explained by the presence of a thin spot on the wall of the cyst which could have ruptured with an increase in intracystic or endopyelic pressure and then spontaneously closed. Reggio Emilia, Ital] (DR. VILLANI)
UROLOCY
’ OCTOBER
1984
I VOLUME
XXIV. SUMBER
References 1. McLaughlin M, and Pfister G: Spontaneous rupture of renal cyst into the pyelocaliceal system, J Urol 113: 2 (1975). 2. Bjerle SR: Pressure measurement in renal cysts, J Clin Lab 27: 135 (1971). 3. Leoni S: Cisti sierose solitarie del rrne. Arch Ital Urol Nephrol 47: 397 (1979). 4. Steg A: Les affections kystiques due rein de I’adulte, Assoc Franc Ural 69 Session, Paris. .Octbber, 1975. 5. Doremieux 1. Naecele S. Masson I. and Bolla CK: La maladie de Wuriderlic comlivation des ky&n jereux. J Urol Nephrol 79: 512 (1973). 6. Durand 1~: Disparition spontanee d‘une image tumoral. ihid 75: 845 (1969). 7. Vacant A. Beurton J, and Cukier J: Effet d’une lithiase ureteral obstructive sur un kyste solitaire du rein. ihid 79: 43 (1973).
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