A very rare case of bone metaplasia of renal cyst: A case report.

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.

Case Report; Concomitant Left Nutcracker Syndrome and Right Ureteropelvic Junction Obstruction.

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.

Giant Pyonephrosis in an Ectopic Kidney: A Case Report.

Pyonephrosis is characterized by infective hydronephrosis accompanied by suppurative destruction of the renal parenchyma, resulting in partial or complete impairment of renal function. Patients present with wide range of symptoms, they can be asymptomatic in 15% but most of them present with septic features like fever, chills, and flank pain. Urinary tract infections, functional and anatomic obstruction, and anatomic anomalies such as pelvic and horseshoe kidneys are common etiologic factors. We report a 30 years old female patient with giant pyonephrosis in an ectopic kidney. She presented with acute toxic symptoms after she has been experiencing progressive abdominal swelling and pain for a couple of years. Simple nephrectomy was done four weeks after she has been initially treated with percutaneous drainage of the pus and intravenous antibiotics.

Experience in Retrocaval Ureter at Saint Paul's Hospital Millennium Medical College: A Case Series.

Retrocaval ureter is a rare congenital vascular anomaly described as the passage of the ureter behind the inferior vena cava (IVC) and then turning around the IVC to attain the final lateral position. The condition is usually associated with obstruction in the ipsilateral kidney, causing different degrees of hydronephrosis and complications associated with urinary stasis, such as stone formation. Imaging has a crucial role in the diagnosis and management of retrocaval ureter. CT urography may be the procedure of choice to confirm the diagnosis and avoid retrograde ureteropyelography. Indications for treatment include flank pain, recurrent infection, hydronephrosis, and stone formation due to obstruction. Surgical management is standard and can be done through either an open, laparoscopic, or robotic approach. In this case series, we are going to see two cases of retrocaval ureter in a 56-year-old male and a 14-year-old male child who presented with a right flank of less than a couple of months duration. The first case has an associated horseshoe kidney and a solitary secondary stone. Both cases were surgically managed with open ureteral division, relocation, and ureteroureterostomy. Both have uneventful post-operative follow-ups.