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Simple renal cyst in a child
Simple Renal Cyst in Y Child By John
F. Redman,
Ladd
J. Scriber,
Little
Rock,
and
Nabil
K. Bissada
Ark.
Solitary simple renal cysts are uncommon in children. Only 26 instances of this occurrence have been previously reported. ‘~4 A child with a simple renal cyst is the basis for this report. CASE
REPORT
A 3-yr-old black female was admitted to the University Hospital for further evaluation in December 1974 following the finding of a left abdominal mass on physical examination. The presenting symptoms were those of an upper respiratory infection. An excretory urogram demonstrated evidence of a mass lesion involving the lower pole of the left kidney (Fig. I). Previous records and radiographs were reviewed after learning that the child had been evaluated with excretory urography and cystography for a urinary tract infection at age 4 mo. The suggestion of displacement bf the left-sided calyces was present then but not nearly so pronounced as on this admission. Ultrasonography demonstrated a cystic mass (Figs. 2 and 3). Transillumination was fruitless. On transperitoneal exploration a simple cyst (5 x 8 cm) of the lower pole of the left kidney was exposed (Fig. 4). The cyst was unroofed and its base was smooth. A small ectopic pancreas was also removed from the antimesenteric border of the jejunum. The patient’s recovery was uneventful. DISCUSSION
DeWeerd’s and Simon’s criteria for a simple renal cyst are: (I) The cyst is unilocular; (2) there is no communication between the cavity of the cyst and the renal pelvis; (3) the cavity of the cyst is lined with epithelium; (4) no renal elements are contained within the cyst wall; (5) a localized region of the kidney is involved; (6) the uninvolved renal tissue is relatively normal, grossly and microscopically; and (7) the renal pelvis and ureters are patent.’
Fig. 1. EXC&G “ry urogra Im showing displacement of lower pole collecting structures.
0 I976 by Grune & Stratton,
Inc.
Journal of Pediatric Surgery, Vol. 11, No. 1 (February),
1976
117
transverse 3. Prone Fig. sonogram through left kidney.
Renal cyst as exposed Fig. 4. transperitoneal exploration.
119
CASE REPORTS
The presence of a simple renal cyst in a child is si nificant in that it must be differentiated s angiography, and from the more commonly occurring nephroblastomas. *6 Nephrotomography, ultrasonography have all been used in differentiating childhood masses.4’7 Ahmed employed cystography following a percutaneous cyst puncture prior to surgery but later stated that the procedure was not recommended in chiJdhood.4 In our patient nephrotomography provided little additional information.’ On the basis of the findings on ultrasonography we did not proceed with arteriography but chose surgical exploration instead.’
REFERENCES 1. DeWeerd JH, Simon HB: Simple renal cysts in children: Review of the literature and report of five cases. J Ural 75:912, 1956 2. Zaidi ZH, Campbell JS: Simple renal cyst in infancy. Br J Ural 33:149, 1961 3. Staubitz WJ, Jewett TC Jr, Pletman RJ: Renal cystic disease in childhood. J Ural 90: 8, 1963 4. Ahmed S: Simple renal cysts in childhood. Br J Urol44:71, 1972
5. Gleason DC, McAlister WH, Kissane J: Cystic disease of the kidneys in children. Am J Roentgen01 Radium Ther Nucl Med 100:135, 1967 6. Gwinn JL, Landing BH: Cystic diseases of the kidneys in infants and children. Radio1 Clin North Am 6:191, 1968 7. Bearman S, Sanders RC: B-scan ultrasound in the evaluation of pediatric abdominal masses. Radiology 108: 1 I I, 1973
F. Redman,
Ladd
J. Scriber,
Little
Rock,
and
Nabil
K. Bissada
Ark.
Solitary simple renal cysts are uncommon in children. Only 26 instances of this occurrence have been previously reported. ‘~4 A child with a simple renal cyst is the basis for this report. CASE
REPORT
A 3-yr-old black female was admitted to the University Hospital for further evaluation in December 1974 following the finding of a left abdominal mass on physical examination. The presenting symptoms were those of an upper respiratory infection. An excretory urogram demonstrated evidence of a mass lesion involving the lower pole of the left kidney (Fig. I). Previous records and radiographs were reviewed after learning that the child had been evaluated with excretory urography and cystography for a urinary tract infection at age 4 mo. The suggestion of displacement bf the left-sided calyces was present then but not nearly so pronounced as on this admission. Ultrasonography demonstrated a cystic mass (Figs. 2 and 3). Transillumination was fruitless. On transperitoneal exploration a simple cyst (5 x 8 cm) of the lower pole of the left kidney was exposed (Fig. 4). The cyst was unroofed and its base was smooth. A small ectopic pancreas was also removed from the antimesenteric border of the jejunum. The patient’s recovery was uneventful. DISCUSSION
DeWeerd’s and Simon’s criteria for a simple renal cyst are: (I) The cyst is unilocular; (2) there is no communication between the cavity of the cyst and the renal pelvis; (3) the cavity of the cyst is lined with epithelium; (4) no renal elements are contained within the cyst wall; (5) a localized region of the kidney is involved; (6) the uninvolved renal tissue is relatively normal, grossly and microscopically; and (7) the renal pelvis and ureters are patent.’
Fig. 1. EXC&G “ry urogra Im showing displacement of lower pole collecting structures.
0 I976 by Grune & Stratton,
Inc.
Journal of Pediatric Surgery, Vol. 11, No. 1 (February),
1976
117
transverse 3. Prone Fig. sonogram through left kidney.
Renal cyst as exposed Fig. 4. transperitoneal exploration.
119
CASE REPORTS
The presence of a simple renal cyst in a child is si nificant in that it must be differentiated s angiography, and from the more commonly occurring nephroblastomas. *6 Nephrotomography, ultrasonography have all been used in differentiating childhood masses.4’7 Ahmed employed cystography following a percutaneous cyst puncture prior to surgery but later stated that the procedure was not recommended in chiJdhood.4 In our patient nephrotomography provided little additional information.’ On the basis of the findings on ultrasonography we did not proceed with arteriography but chose surgical exploration instead.’
REFERENCES 1. DeWeerd JH, Simon HB: Simple renal cysts in children: Review of the literature and report of five cases. J Ural 75:912, 1956 2. Zaidi ZH, Campbell JS: Simple renal cyst in infancy. Br J Ural 33:149, 1961 3. Staubitz WJ, Jewett TC Jr, Pletman RJ: Renal cystic disease in childhood. J Ural 90: 8, 1963 4. Ahmed S: Simple renal cysts in childhood. Br J Urol44:71, 1972
5. Gleason DC, McAlister WH, Kissane J: Cystic disease of the kidneys in children. Am J Roentgen01 Radium Ther Nucl Med 100:135, 1967 6. Gwinn JL, Landing BH: Cystic diseases of the kidneys in infants and children. Radio1 Clin North Am 6:191, 1968 7. Bearman S, Sanders RC: B-scan ultrasound in the evaluation of pediatric abdominal masses. Radiology 108: 1 I I, 1973