ABSTRACT
INTRODUCTION: Renal Osseous Metaplasia (OM) is a rare condition in which mature bone forms within the renal parenchyma, typically as focal cortical lesions. Although it is usually considered a spontaneous and less pathologically significant lesion, it has been observed in damaged renal allografts and other urinary tract sites. The case we present involves a native kidney with a simple renal cyst, where histopathological examination post-tumor enucleation revealed OM, emphasizing its noteworthy presence in clinical settings. CASE PRESENTATION: A 37-year-old female with a history of cesarean delivery and recent emergency surgery presented with abdominal and left flank pain. Initial ultrasound revealed a 4.2 cm anechoic cyst in the lower pole of the left kidney, which was confirmed by abdominal computed tomography (CT-scan as a well-defined fluid density cyst with a thick calcified wall. Surgical enucleoresection identified a Stoney hard mass with a unilocular cyst, histopathologically diagnosed as a simple renal cyst with metaplastic bone and hematopoietic elements. The patient had an uneventful postoperative course and remained well during the follow-up. DISCUSSION: Osseous metaplasia (OM) involves extraskeletal bone formation and is associated with factors such as chronic ischemia and inflammation. While rare in renal pathology, it occurs in native kidneys, damaged renal allografts, and the urinary tract, posing radiological challenges in differentiating it from calcification. Accurate diagnosis requires histopathological examination because of the difficulties in distinguishing OM from calcification on imaging studies. CONCLUSION: This case revealed Osseous Metaplasia in a simple cyst of the native kidney, urging vigilance in the diagnosis. While generally benign, its occurrence in damaged renal areas emphasizes its clinical significance, prompting further research. Heightened awareness and thorough examination are crucial for accurate diagnosis and patient management.
ABSTRACT
We report rare case of concomitant left nutcracker syndrome and right ureteropelvic junction obstruction (UPJO) on adult female patient diagnosed by CT urogram after she presented with intermittent bilateral flank pain. For this we did Anderson-Hynes pyeloplasty for right ureteropelvic obstruction, it was laparoscopic initially but due to difficulty of stenting it is changed to open. She had smooth post-op course then discharged on 3rd post-op day. Symptoms of nutcracker syndrome are not that much bothersome for the patient so we planned to follow her conservatively.
ABSTRACT
Purpose: With nearly 500,000 new cases and over 150,000 deaths worldwide in 2020, renal cancers remain a significant component of the global burden of cancer. The aim of this study is to describe the clinical presentation, peri-operative condition and short-term outcome of patients operated with the primary diagnosis of renal cell carcinoma (RCC) at a large tertiary care referral center. Patients and Methods: A retrospective institution-based study was done. The study population consisted of all patients who were operated for a primary diagnosis of renal cell carcinoma from January 1st, 2015, to December 31st, 2020, at the Urology Unit of St Paul's Hospital Millennium Medical College. Results: The final cohort consisted of 107 patients (mean (standard deviation) age 49 (±14) years, 48% male, 46% residence in Addis Ababa). The most common presenting complaint was flank pain (65%), followed by hematuria (34%) and abdominal mass (6%). One patient had the classic triad of RCC. The median (IQR) duration of illness was 9(7-11) months. Fourteen (13%) patients were asymptomatic and diagnosed incidentally. Over half (57%) of the cohort were clinical TNM stage II, with the remaining 17%, 18% and 8% being stage I, III and IV, respectively. Nearly all patients (94%) underwent open radical nephrectomy with a transabdominal approach. Most patients (61%) had no Clavien-Dindo grade complications, and a minority (11%) experienced post-operative complications (7% postoperative bleeding, 6% hospital acquired pneumonia, 3% surgical site infection). The median (IQR) length of stay was 6 (5-7.6) days. Nearly all patients (94%) were discharged and improved. Conclusion: In this retrospective study, we have shown that patients operated for RCC are a low-risk cohort with few comorbidities, have a relatively short symptomatic course and good discharge outcome. Further prospective studies are needed to show the long-term outcome and factors associated with such outcomes in this patient population.