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A case of an isolated hydatid cyst in the right kidney
Journal Pre-proof A case Of An Isolated Hydatid Cyst In The Left Kidney
Ahmed Samet, Mohamed Amine Mseddi, Majed Hamza, Maroua Walha, Ibtissem Bahri, Mourad Hadjslimane PII:
S2214-4420(19)30346-8
DOI:
https://doi.org/10.1016/j.eucr.2019.101047
Reference:
EUCR 101047
To appear in:
Urology Case Reports
Received Date:
25 August 2019
Accepted Date:
15 October 2019
Please cite this article as: Ahmed Samet, Mohamed Amine Mseddi, Majed Hamza, Maroua Walha, Ibtissem Bahri, Mourad Hadjslimane, A case Of An Isolated Hydatid Cyst In The Left Kidney, Urology Case Reports (2019), https://doi.org/10.1016/j.eucr.2019.101047
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier.
Journal Pre-proof
A case Of An Isolated Hydatid Cyst In The Left Kidney
Ahmed Samet(corresponding author) (email: [email protected]): Urology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Mohamed Amine Mseddi : Urology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia
Majed Hamza: Urology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Maroua Walha: pathology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Ibtissem Bahri: pathology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Mourad Hadjslimane : Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia
Journal Pre-proof Isolated renal hydatid cyst is rare. Preoperative diagnosis may be difficult because clinical, biochemical and radiologic findings can not eliminate the diagnosis of renal cancer in its cystic form. Open surgery is traditionally the gold standard.
Journal Pre-proof
introduction: Hydatid cyst disease is a parasitosis caused by a tapeworm: Echinococcus granulosus [1]. The kidney is the most commonly affected organ of the urinary tract .However, isolated renal involvement is rare (2–4% of all cases) [2]. The causative tapeworm lives in the small intestine of definitive hosts, such as dogs and other canids. Its diagnosis is easy and mainly based on ultrasound and CT-scan. The treatment is mainly surgical. case report: A 40-year-old woman, without any noticeable medical history, was admitted into our hospital. She was complaining of the presence of chronic right flank pain and mild fever. The clinical examination was normal. The laboratory findings, including liver, renal function tests and hydatid serology were normal. The CT-scan of the abdomen confirmed a 9 cm renal mass with a 3 cm cyst inside (figure 1). Renal hydatid cyst (RHC) was suspected. No other localizations were found. The patient was managed by open surgery: lombotomy. We were obliged to make a tumorectomy because the investigations couldn’t eliminate the diagnosis of renal cancer in its cystic form (figure 2). The postoperative period was uneventful. The patient was discharged on day 5 after an uneventful postoperative course. He took Oral albendazole for 4 weeks on discharge. Anatomopathology confirmed the diagnosis of hydatid cyst of the kidney (figure 3). The patient is on regular follow-up in outpatient department in health and normal renal function.
discussion: The RHC represents about 2.5% of the whole localizations and most often unilateral and unique, however cases of multiple and even bilateral were reported. The RHC might remain asymptomatic for years in case of slow evolvement. The patients with RHC usually present with vague pain in the lumbar or flank region [3].The patient might present hematuriae, which is a pathognnomonic sign of cyst rupture, a finding that is present in only 10–20% of the cases. The CT-scan remains the most suitable examination. It could be ordered promptly, and mostly for differential diagnosis once the ultrasonographic IV and V types are declared. Differential diagnosis of hydatid cysts of the kidney from other space-occupying renal masses can be challenging. However, the combination of factors such as the slow increase of growth, the characteristic imaging findings, and serological test results can be revealing [3]. Considering the insufficiencies of medical treatment (with bi-imidazoles like albendazole 10– 15 mg/kg/day in two divided doses), used especially in cases of small cysts (lower than 30 mm), and the potential risk of interventional radiology, the treatment of RHC remains surgical. The choice of the treatment approach depends on three basic elements: the volume of the mass, the relation of this mass with neighboring tissues and the extra-renal and abdominal localization of another hydatid cyst. Therefore, the lombotomy is the most used approach. Also to avoid the spread of the disease, the cyst should be removed without rupture especially in this case where the diagnosis of kidney cancer is possible. Laparoscopic nephrectomy
Journal Pre-proof entails risk of cyst rupture, intra-peritoneal dissemination, and incomplete removal of the hydatid cyst [4]. Retroperitoneoscopic approach is favored and is increasingly used as it provides the same outcome, less morbidity and a better esthetic result but only some studies were published [5]. In our case, we considered feasible a retroperitoneal approach through lombotomy incision. The kidney was reserved, because the hydatid cyst did not invade a major renal part and renal function tests were normal. The cyst was not opened intra operatively. However, partial or total nephrectomy is required in the cases found with almost completely destroyed kidney. Nevertheless, the prognosis remains still very good whenever other localizations are not associated. Conclusion: A limited number of isolated renal hydatid cysts are reported in the literature. The RHC has to be evoked in all renal cystic lesions, especially in endemic regions of the. Careful diagnosis and complete pathophysiology of urinary tract hydatidosis are needed to be clarified. The surgical approche remains the treatment of choice.
References: 1. S. Adanur, E. Koç, T. Ziypak, T. Yapanoglu, and O. Polat, “Giant isolated renal cyst hydatid: from diagnosis to treatment,” Archivio Italiano di Urologia e Andrologia, vol. 86, no. 2, pp. 144–145, 2014. 2. S. A. Kumar, A. Shetty, C. Vijaya, and V. Geethamani, “Isolated primary renal echinococcosis: a rare entity,” International Urology and Nephrology, vol. 45, no. 3, pp. 613–616, 2013. 3. S. Qadri, R. K. Sherwani, and M. Ahmed, “Isolated cystic echinococcosis of kidney burlesquing as renal cell carcinoma: a diagnostic pitfall,” Annals of Parasitology, vol. 61, no. 1, pp. 57–60, 2015. 4. Basiri A, Nadjafi-Semnani M, Nooralizadeh A. Case report: Laparoscopic partial nephrectomy for isolated renal hydatid disease. J Endourol. 2006;20:24–6
5. Ozden E, Bostanci Y, Mercimek MN, Yakupoglu YK, Yilmaz AF, Sarıkaya S. Renal hydatid cyst treatment: retroperitoneoscopic “closed cyst” pericystectomy. Int J Urol. 2011;18:237–239
Journal Pre-proof
Figure 1: CT scan showing a 9 cm cyst on the right kidney Figure 2: hydatid cyst removed by open surgery Figure 3: pericystium with lyphocystic infiltrated renal parenchyma and atrophic and dilated renal tubules.
Ahmed Samet, Mohamed Amine Mseddi, Majed Hamza, Maroua Walha, Ibtissem Bahri, Mourad Hadjslimane PII:
S2214-4420(19)30346-8
DOI:
https://doi.org/10.1016/j.eucr.2019.101047
Reference:
EUCR 101047
To appear in:
Urology Case Reports
Received Date:
25 August 2019
Accepted Date:
15 October 2019
Please cite this article as: Ahmed Samet, Mohamed Amine Mseddi, Majed Hamza, Maroua Walha, Ibtissem Bahri, Mourad Hadjslimane, A case Of An Isolated Hydatid Cyst In The Left Kidney, Urology Case Reports (2019), https://doi.org/10.1016/j.eucr.2019.101047
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier.
Journal Pre-proof
A case Of An Isolated Hydatid Cyst In The Left Kidney
Ahmed Samet(corresponding author) (email: [email protected]): Urology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Mohamed Amine Mseddi : Urology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia
Majed Hamza: Urology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Maroua Walha: pathology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Ibtissem Bahri: pathology Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia Mourad Hadjslimane : Department, Academic Hospital Habib Bourguiba. Sfax, Tunisia
Journal Pre-proof Isolated renal hydatid cyst is rare. Preoperative diagnosis may be difficult because clinical, biochemical and radiologic findings can not eliminate the diagnosis of renal cancer in its cystic form. Open surgery is traditionally the gold standard.
Journal Pre-proof
introduction: Hydatid cyst disease is a parasitosis caused by a tapeworm: Echinococcus granulosus [1]. The kidney is the most commonly affected organ of the urinary tract .However, isolated renal involvement is rare (2–4% of all cases) [2]. The causative tapeworm lives in the small intestine of definitive hosts, such as dogs and other canids. Its diagnosis is easy and mainly based on ultrasound and CT-scan. The treatment is mainly surgical. case report: A 40-year-old woman, without any noticeable medical history, was admitted into our hospital. She was complaining of the presence of chronic right flank pain and mild fever. The clinical examination was normal. The laboratory findings, including liver, renal function tests and hydatid serology were normal. The CT-scan of the abdomen confirmed a 9 cm renal mass with a 3 cm cyst inside (figure 1). Renal hydatid cyst (RHC) was suspected. No other localizations were found. The patient was managed by open surgery: lombotomy. We were obliged to make a tumorectomy because the investigations couldn’t eliminate the diagnosis of renal cancer in its cystic form (figure 2). The postoperative period was uneventful. The patient was discharged on day 5 after an uneventful postoperative course. He took Oral albendazole for 4 weeks on discharge. Anatomopathology confirmed the diagnosis of hydatid cyst of the kidney (figure 3). The patient is on regular follow-up in outpatient department in health and normal renal function.
discussion: The RHC represents about 2.5% of the whole localizations and most often unilateral and unique, however cases of multiple and even bilateral were reported. The RHC might remain asymptomatic for years in case of slow evolvement. The patients with RHC usually present with vague pain in the lumbar or flank region [3].The patient might present hematuriae, which is a pathognnomonic sign of cyst rupture, a finding that is present in only 10–20% of the cases. The CT-scan remains the most suitable examination. It could be ordered promptly, and mostly for differential diagnosis once the ultrasonographic IV and V types are declared. Differential diagnosis of hydatid cysts of the kidney from other space-occupying renal masses can be challenging. However, the combination of factors such as the slow increase of growth, the characteristic imaging findings, and serological test results can be revealing [3]. Considering the insufficiencies of medical treatment (with bi-imidazoles like albendazole 10– 15 mg/kg/day in two divided doses), used especially in cases of small cysts (lower than 30 mm), and the potential risk of interventional radiology, the treatment of RHC remains surgical. The choice of the treatment approach depends on three basic elements: the volume of the mass, the relation of this mass with neighboring tissues and the extra-renal and abdominal localization of another hydatid cyst. Therefore, the lombotomy is the most used approach. Also to avoid the spread of the disease, the cyst should be removed without rupture especially in this case where the diagnosis of kidney cancer is possible. Laparoscopic nephrectomy
Journal Pre-proof entails risk of cyst rupture, intra-peritoneal dissemination, and incomplete removal of the hydatid cyst [4]. Retroperitoneoscopic approach is favored and is increasingly used as it provides the same outcome, less morbidity and a better esthetic result but only some studies were published [5]. In our case, we considered feasible a retroperitoneal approach through lombotomy incision. The kidney was reserved, because the hydatid cyst did not invade a major renal part and renal function tests were normal. The cyst was not opened intra operatively. However, partial or total nephrectomy is required in the cases found with almost completely destroyed kidney. Nevertheless, the prognosis remains still very good whenever other localizations are not associated. Conclusion: A limited number of isolated renal hydatid cysts are reported in the literature. The RHC has to be evoked in all renal cystic lesions, especially in endemic regions of the. Careful diagnosis and complete pathophysiology of urinary tract hydatidosis are needed to be clarified. The surgical approche remains the treatment of choice.
References: 1. S. Adanur, E. Koç, T. Ziypak, T. Yapanoglu, and O. Polat, “Giant isolated renal cyst hydatid: from diagnosis to treatment,” Archivio Italiano di Urologia e Andrologia, vol. 86, no. 2, pp. 144–145, 2014. 2. S. A. Kumar, A. Shetty, C. Vijaya, and V. Geethamani, “Isolated primary renal echinococcosis: a rare entity,” International Urology and Nephrology, vol. 45, no. 3, pp. 613–616, 2013. 3. S. Qadri, R. K. Sherwani, and M. Ahmed, “Isolated cystic echinococcosis of kidney burlesquing as renal cell carcinoma: a diagnostic pitfall,” Annals of Parasitology, vol. 61, no. 1, pp. 57–60, 2015. 4. Basiri A, Nadjafi-Semnani M, Nooralizadeh A. Case report: Laparoscopic partial nephrectomy for isolated renal hydatid disease. J Endourol. 2006;20:24–6
5. Ozden E, Bostanci Y, Mercimek MN, Yakupoglu YK, Yilmaz AF, Sarıkaya S. Renal hydatid cyst treatment: retroperitoneoscopic “closed cyst” pericystectomy. Int J Urol. 2011;18:237–239
Journal Pre-proof
Figure 1: CT scan showing a 9 cm cyst on the right kidney Figure 2: hydatid cyst removed by open surgery Figure 3: pericystium with lyphocystic infiltrated renal parenchyma and atrophic and dilated renal tubules.