Giant Renal Cyst Causing Malnutrition and Weight Loss: A Case Report

Renal cysts are among the most common benign lesions of the urinary system. Simple renal cysts are generally asymptomatic and do not require treatment; however, when they reach a considerable size, they may compress adjacent tissues, causing pain, hypertension, hydronephrosis, or impaired renal function. This article presents a clinical case of successful surgical management of a giant left renal cyst measuring 22 × 24 cm in a 55-year-old patient. The cyst caused compression of surrounding structures, manifested by pain and abdominal distension. Based on computed tomography findings, the cyst was classified as Bosniak type II. Laparoscopic cyst excision with evacuation of 5100 mL of fluid was performed. The postoperative course was uneventful, and a follow-up examination at 3 months revealed no recurrence. This clinical case demonstrates the effectiveness of the laparoscopic approach even in cases of giant renal cysts. Laparoscopic excision ensures minimal invasiveness while maintaining high surgical efficacy. Particular attention during such procedures should be paid to meticulous hemostasis, prevention of intraoperative cyst rupture, and complete removal of the cyst wall.

To explore the safety and feasibility of performing retroperitoneoscopic renal cystectomy in a case of massive giant renal cyst in a solitary hydronephrotic renal unit. We have described the retroperitoneal three-trocar technique. The role of laparoscopic renal cyst ablation in giant symptomatic renal cysts and non-polycystic kidney disease has been discussed. The patient was successfully managed by retroperitoneoscopic deroofing using a three-port technique. The operating room time was 90 minutes and her hospital stay lasted 54 hours. The fluid cytology and cyst histology were negative for tumor. Complete resolution of the cyst was noted on a follow-up ultrasound done after 2 months. Currently at 9-month follow up, the patient is ultrasonographically free of any cyst recurrence or hydronephrosis. The retroperitoneal approach is feasible for marsupializing giant symptomatic renal cysts and appears to be safe for solitary symptomatic renal units too. It shortens the overall operating time and avoids the complications and demerits of transperitoneal access.

BACKGROUNDRenal cysts, especially the cortical type, are a prevalent renal pathology. Most cases are asymptomatic and detected incidentally during abdominal imaging examination for unrelated complaints. They are often benign, but they can rarely transform into cystic renal malignancies. When huge or complicated, especially with an abscess, it may become symptomatic from the renal capsular stretch or inflammation. The open surgical, endoscopic, laparoscopic, and robotic approaches are available for symptomatic renal cyst treatment. This paper aims to report our experience in the management of a case of a giant renal cyst abscess.CASE SUMMARYThis is a 26-year-old housewife who was referred to the urology outpatient clinic with a history of left flank pain and swelling for 5 months, with the transabdominal ultrasound scan and computerized tomography scan findings of a huge left renal cortical cyst (Bosniak I). She had associated anorexia, weight loss, nausea, and intermittent fever, which on one occasion was severe and high-grade with chills and rigors. This warranted hospital admission, analgesic and antibiotic therapy. The physical examination was unremarkable at presentation except for a ballotable and mildly tender left lumbar cystic mass. Her vital signs were stable. There was leukocytosis with relative neutrophilia. Further review of the imaging films confirmed the diagnosis of a left giant renal cortical cyst abscess. She was counselled and had open surgical exploration, drainage of 300 mL of pus, cyst unroofing with marsupialization, and was discharged home on the 10th postoperative day.CONCLUSIONTreatment of giant simple renal cortical cyst abscesses should be individualized depending on the pathology in question, the surgeon’s experience, patient preference and availability of facilities for endoscopic, laparoscopic or robotic modalities. Notwithstanding open surgical exploration, cyst unroofing and marsupialization are useful modalities in giant renal cortical cyst abscesses and are associated with patient satisfaction.

Sclerotherapy of a giant renal cyst with povidone-iodine.

Simple renal cysts are among the most common cystic lesions of the kidney. Renal cysts most often remain asymptomatic, but rarely these cysts may become huge in size and result in significant symptoms. Giant renal cysts present a technical challenge in terms of surgical management. Although laparoscopic procedures have been performed successfully at experienced centres, intraperitoneal marsupialization via open approach may be a feasible option at less experienced centres. We report a case of a young female with a giant (24 × 18 cm) renal cyst of Bosniak type-II variety. De-roofing and intraperitoneal marsupialization of the cyst was performed. At the 1-year follow-up, she was asymptomatic, with no residual cyst.

BackgroundIsolated renal hydatid cysts of the kidney are a rare occurrence that account for about 2–3% of all hydatidoses. They can stay asymptomatic for years and could have a variable presentation on imaging techniques, which results in a challenging diagnostic process.Case presentationWe report a 22-year-old Caucasian male with a large cyst on the upper pole of the left kidney that had no septations nor membrane calcifications on computed tomography, which led to mistakenly considering it a simple renal cyst. The true diagnosis was identified intraoperatively and proven postoperatively by pathology.ConclusionsThis case highlights the importance of keeping echinococcosis in mind when treating suspected renal cysts and tumors to avoid incorrect treatment and possible content spillage, anaphylaxis, and peritoneal dissemination.

Sclerotherapy of a Giant Renal Cyst with Povidone-Iodine

Remission of erythrocytosis and hypertension after treatment of a giant renal cyst

The Prevalence of Simple Renal and Hepatic Cysts Detected by Spiral Computed Tomography

BackgroundRenal cysts are common in old patients, and usually remain untreated. Giant renal cyst measuring more than 15 cm in diameter and containing more than 1500 mls of serous fluid are rarely seen. We report a case of a 75-year-old man with a giant right renal cyst.Case presentationA 75-year-old man presented with a five years history of suprapubic pain, abdominal distension. He had no urological symptoms. Physical examination revealed a distended abdomen with shifting dullness. Routine hematology, biochemistry, and serum tumor markers were within normal limits. Erroneously diagnosed as ascites on ultrasonographic examination. Abdominal paracentesis of supposed ascites was performed. The diagnosis of giant renal cyst was finally made by Computed tomography (CT) and patient underwent continuous percutaneous catheter drainage with negative pressure, whereby 8 liters of fluid were removed with negative cytology. Subsequent Computed tomography after 6 months revealed disparition of the cysts, and the patient remained asymptomatic.ConclusionGiant renal cysts are uncommon; we conclude that the CT remains the best exam in patients evaluated for giant renal cyst. This to the best of our knowledge is the largest renal cyst in the medical literature. Studies are needed with particular attention to the factors associated with renal cyst enlargement.

Simple Cysts of the Kidney: A Review and Update

To evaluate the relationships between simple renal cysts and arterial hypertension and whether their evacuation decreases the blood pressure (BP). In a cross-sectional design, we analyzed 184 study participants with cysts and compared hypertensive and nonhypertensive among them. Outcomes were the number, the size and the location of a cyst. In a cross-over design, we first evaluated the change in absolute value of SBP, DBP and mean BP in 62 hypertensive patients who underwent percutaneous evacuation of a cyst and then the decrease of BP as a categorical variable that comprised all study participants. There were 55% giant renal cysts among hypertensive and 24% among nonhypertensive patients (P = 0.0001). The prevalence rates of multiple and peripheral cysts in hypertensive and nonhypertensive patients were similar to those of single and perihilar cysts, respectively. Significant differences in SBP, DBP and mean BP were found between pretreatment readings and 3 days, 1 month, 3 months and 6 months after cyst evacuation (P < 0001). The differences were significant in all hypertensive patients (P < 0.001). There were less hypertensive patients 3 days after treatment than before treatment (P < 0.0001). An apparent association between the size of a simple renal cyst and hypertension was found, and aspiration of cysts resulted in a reduction of BP. Location and number of cysts were not related to BP.

Cases of renal cell carcinoma (RCC) presenting as a simple cyst are extremely rare. We herein report the case of a patient with RCC diagnosed as a simple renal cyst preoperatively. A 39-year-old female patient presented with abdominal pain for 3 months. Ultrasonography and contrast-enhanced computed tomography revealed a simple cyst in the left kidney. The patient underwent laparoscopic decortication of the renal cyst. Biochemical analysis of the cystic fluid revealed unusually low levels of potassium, sodium, calcium and glucose, and the histological examination of the floor of the cyst indicated malignancy. Laparoscopic nephrectomy was performed 20 days later and the pathological examination confirmed the diagnosis of RCC of the clear cell type. At the 2-year follow-up, the patient remained well and recurrence-free on imaging. The aim of the present study was to emphasize the importance of recognizing that RCC may occur in what appears to be a simple renal cyst based on imaging results. Biochemical analysis of the cystic fluid may help identify the presence of malignancy.

BackgroundSimple renal cysts usually have benign clinical features. We report a rare case of papillary renal cell carcinoma (RCC) associated with a large recurrent simple cyst following sclerotherapy.Case PresentationA 47-year-old Japanese woman received minocycline sclerotherapy for a large (9 cm in diameter) simple left renal cyst in May 2005. The cyst regrew, and second-line sclerotherapy with ethanol was performed in November 2005. Three years later, she developed papillary RCC on the wall of the recurrent renal cyst. Radical nephrectomy was performed, but the patient died of metastatic disease 15 months after surgery.ConclusionMalignant transformation from recurrent simple renal cyst to RCC may occur in the years following sclerotherapy, underscoring the need for long-term follow-up.

A case of renal carcinoma in a giant solitary renal cyst is reported. Ultrasonography and CT showed an apparently benign left renal cyst except for wall irregularity. Cytological examination and fat analysis of the cyst content were negative but the fluid was haemorrhagic in nature. Frozen section of the cyst wall revealed malignancy and further histopathologic examination indicated renal cell carcinoma.