Diagnosis and Treatment of Abnormally Calcified Renal Masses (3 Case Reports)

Qingwen L Sheng X

doi:10.4172/2380-5439.1000131

Abstract

Object Improve the diagnosis and treatment of calcified renal masses. Method We respectively reviewed 3 cases of abnormally calcified renal masses admitted to our hospital. We evaluated the clinical manifestations in the patients we treated and reviewed the literature regarding the diagnosis and treatment of calcified renal masses. Case 1, a 21 year old male, was evaluated for a right renal space-occupying lesion found incidentally on physical examination. CT imaging revealed a space-occupying lesion in the middle lower pole of the right kidney with peripheral circular calcifications and irregular calcifications. The lesion was low density on CT. Case 2, a 44 year old male, presented with right flank swelling pain and discomfort for 10 days. KUB and CT imaging demonstrated an abnormal round calcification in the dorsal midpole of the left kidney. Case 3, a 53 year old female, presented with dull left flank pain for more than 2 years. KUB and CT showed a round calcified lesion in the upper pole of the left kidney. Results The diagnosis of renal cancer was made before surgery in patient 1 and radical nephrectomy was carried out. The pathological diagnosis was papillary renal cell carcinoma. The patient was followed for 27 months and wasfree of recurrence and metastases. The preoperative diagnosis of patient 2 was benign renal tumor. The patient underwent enucleation of the renal tumor. Pathologic examination revealed clear cell renal carcinoma. A radical nephrectomy was then performed. The patient was followed for 37 months and was free of recurrence and metastases. The preoperative diagnosis in patient 3 was left renal calyceal stones. The patient underwent wedge resection of left renal parenchyma. Pathologic examination revealed an abnormal left renal calcification with inflammatory cell infiltration. The patient was followed for 39 months and remained in good health. Conclusion Calcified renal masses are rare manifestations of renal cancer. It is difficult to make the diagnosis before surgery, but the prognosis is favorable. Nephron sparing surgery (NSS) is the choice of treatment.

Highlights

Renal mass calcifications, especially non-peripheral calcifications have been considered an indicator of malignancy [1]
The diagnosis of renal cancer was made before surgery in patient 1 and radical nephrectomy was carried out
It is difficult to make the diagnosis before surgery, but the prognosis is favorable

Summary

Introduction

Especially non-peripheral calcifications (such as punctiform or cord-like calcifications) have been considered an indicator of malignancy [1]. Peripheral curvilinear calcifications are more common in benign renal cysts, 20% are malignant. In 1905, Albrecht first reported a calcified fibrous capsule surrounding a renal cancer [2]. We reviewed 3 abnormally calcified renal masses recently diagnosed at our hospital. It was difficult to make the diagnosis because of the different pathologic findings. Clinical data We admitted 3 patients with abnormally calcified renal masses to our hospital since 2008. CT, IVU or ultrasonography confirmed a mass with calcifications. The patients did not have a history of urinary calculi or hypercalcemia. One patient was diagnosed incidentally during physical examination and the other 2 patients presented with flank discomfort

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Results

Conclusion