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Case profile: Unusual calcified septum in renal cyst
CASE PROFILE:
UNUSUAL
CALCIFIED
An excretory urogram was performed for evaluation of hypertension in a sixty-eight-year-old woman. She had no history of infection of the urinary tract nor trauma to the flank. Results of laboratory tests were normal. Excretory urogram and bolus nephrotomogram demonstrated a radiolucent mass in the lower
SEPTUM IN RENAL CYST
pole of the left kidney and the calyces were not distorted. The mass contained a rectangular area of calcification with distinct borders. The calcification which was rather homogeneous in texture and appeared organized was within the mass in a nonperipheral location (Fig. 1A and B). A midstream arteriogram demonstrated three renal
FIGURE 1. (A) Roentgenogram from excretory urogram reveals well-defined rectangular area of calci$cation at lateral perimeter of lower pole of left kidney. (B) Tomogram j-om intravenous bolus nephrotomogram shows radiolucent muss at lower pole of le$ kidney; calcijication appears within mass in nonperipheral location. (C) Left selective renal arteriogram (one of three left renal arteries) reveals no evidence of tumor vascularity, stain, or venous abnormality within mass.
86
UROLOGY
/ JULY 1976
/ VOLUME
VIII,
NUMBER
1
arteries supplying left kidney. Left selective renal arteriograms of the two renal arteries supplying the renal parenchyma in the region of the mass demonstrated no evidence of tumor vascularity, tumor stain, or venous abnormalities (Fig. 1C). The kidney was explored, and a simple cyst with an incomplete, calcified septum was found (Fig. 2). This case presented an unusual radiographic and gross pathologic pattern of calcification in a renal cyst. A previous review of calcified renal masses at this institution noted that the apparent location of the calcification was more meaningful than the pattern of calcification in the differentiation of cyst and tumor. * Nevertheless, our case illustrates the dilemma presented by radiographic evaluation of a renal tumor with nonperipheral calcification. The high likelihood that such a mass with nonperipheral calcification is malignant usually mandates exploration. N. James Hawthorne, M.D. Horst Zincke, M.D. (Reprints) Robert R. Hatter-y, M.D. Mayo Clinic and Mayo Foundation Rochester, Minnesota 55901 (A) Lower pole cyst opened; FIGURE 2. septum divides cyst into two incomplete parts. (B) Removed calcijed septum within cyst wall.
UROLOGY
/
JULY 1976
/ VOLUME VIII, NUMBER 1
*DANIELS, W. W., JR., et al. : Calcified renal masses: a review often years’experience at the Mayo Clinic, Radiology 103: 503 (1972).
87
UNUSUAL
CALCIFIED
An excretory urogram was performed for evaluation of hypertension in a sixty-eight-year-old woman. She had no history of infection of the urinary tract nor trauma to the flank. Results of laboratory tests were normal. Excretory urogram and bolus nephrotomogram demonstrated a radiolucent mass in the lower
SEPTUM IN RENAL CYST
pole of the left kidney and the calyces were not distorted. The mass contained a rectangular area of calcification with distinct borders. The calcification which was rather homogeneous in texture and appeared organized was within the mass in a nonperipheral location (Fig. 1A and B). A midstream arteriogram demonstrated three renal
FIGURE 1. (A) Roentgenogram from excretory urogram reveals well-defined rectangular area of calci$cation at lateral perimeter of lower pole of left kidney. (B) Tomogram j-om intravenous bolus nephrotomogram shows radiolucent muss at lower pole of le$ kidney; calcijication appears within mass in nonperipheral location. (C) Left selective renal arteriogram (one of three left renal arteries) reveals no evidence of tumor vascularity, stain, or venous abnormality within mass.
86
UROLOGY
/ JULY 1976
/ VOLUME
VIII,
NUMBER
1
arteries supplying left kidney. Left selective renal arteriograms of the two renal arteries supplying the renal parenchyma in the region of the mass demonstrated no evidence of tumor vascularity, tumor stain, or venous abnormalities (Fig. 1C). The kidney was explored, and a simple cyst with an incomplete, calcified septum was found (Fig. 2). This case presented an unusual radiographic and gross pathologic pattern of calcification in a renal cyst. A previous review of calcified renal masses at this institution noted that the apparent location of the calcification was more meaningful than the pattern of calcification in the differentiation of cyst and tumor. * Nevertheless, our case illustrates the dilemma presented by radiographic evaluation of a renal tumor with nonperipheral calcification. The high likelihood that such a mass with nonperipheral calcification is malignant usually mandates exploration. N. James Hawthorne, M.D. Horst Zincke, M.D. (Reprints) Robert R. Hatter-y, M.D. Mayo Clinic and Mayo Foundation Rochester, Minnesota 55901 (A) Lower pole cyst opened; FIGURE 2. septum divides cyst into two incomplete parts. (B) Removed calcijed septum within cyst wall.
UROLOGY
/
JULY 1976
/ VOLUME VIII, NUMBER 1
*DANIELS, W. W., JR., et al. : Calcified renal masses: a review often years’experience at the Mayo Clinic, Radiology 103: 503 (1972).
87