Manuela Stoicescu
University of Oradea, Romania
: J Kidney
Objective: The main objective of this presentation is to put in discussion if a simple renal cyst is really an innocent problem?! The diagnosis of a simple renal cyst is one of the most common diagnoses from the medical practice. Frequent is asymptomatic and represent a random discovering after a routine abdominal ultrasound examination. Is considered a benign formation and the patients are advice to follow in time the cyst to observe if increase in dimensions after repeated abdominal ultrasounds at 3 or 6 months. Without an abdominal ultrasound, many patients didn�??t know that they have a simple renal cyst. Material & Methods: Present the situation of a patient 54 years old, hypertensive with three medications in the therapeutic scheme (Lisinopril 2x10mg/day, Betaloc-Zok 2x25mg/day and Losartan 10mg 1 drug/day), with diastolic pressure resistant at therapy (BP=140/110mmhg), who came at a routine consultation to check the value of blood pressure. This was 160/110mmhg under therapy, HR=86bates/min, rhythmic, EKG showed left ventricular hypertrophy and performed an abdominal ultrasound. The surprise was to be discover a gigantic (very enlarge) 18/19cm simple renal cyst on the left kidney and of course in this moment appear the reality that the arterial hypertension was secondary renal hypertension. The patient was advice to perform puncture of the cyst with evacuation of the fluid or surgical remove with complete capsule, but the patient refused in the first instance. The cyst has a rapidly growing in dimensions at the second evaluation after 3 month increase at 23/22cm. After realized this fast growing and that after solve the simple renal cyst can decrease the value of blood pressure he accepted the puncture.The surprise was that after the puncture of the cyst ultrasound guided appears hemorrhagic fluid and was evacuated. In three days the fluid reappears fast in the same quantity. The second evacuation eliminated again hemorrhagic fluid �??for this reason the patient performed a laparotomy. The left renal cyst was removed complete with capsule and inside of the capsule on the walls there were many small villi with irregular borders. The histopathology examination confirmed safe the diagnosis of papillary renal cell carcinoma. The collection of fluid inside of the cyst was actually a liquid neoplastic hemorrhagic and inexhaustible and was recovering quickly after puncture. Results & Discussions: The case is surprising because in the first instance at the abdominal ultrasound put in evidence enlarge simple renal cyst with dorsal acoustic enhancement which is a ultrasound sign for the presence of the fluid inside of the cyst, but can�??t mention the difference between a simple serous-citrine fluid and a hemorrhagic fluid. Without puncture of the cyst ultrasound guided is really very difficult to know this. The very small vili on the wall of the cyst is possible to remain unknown. Only the surgical removed of the renal cyst and histopathology examination can relive the real diagnosis. Conclusion: Sometimes, apparently a simple enlarge renal cyst, with fast growing, can hide a neoplastic hemorrhagic fluid, inexhaustible in context of unknown papillary cell carcinoma.
Manuela Stoicescu is a Consultant Internal Medicine Physician (PhD in Internal Medicine), Assistant Professor of University of Oradea, Faculty of Medicine and Pharmacy, Medical Disciplines Department, Romania. She was invited as a Speaker at more than 30 international conferences is USA, China, Japan, Canada, Thailand, Dubai, Spain and Germany. She is a Committing Organizing Member at many international conferences and Editorial Board Member in two ISSN prestigious journals in USA. She published more than 20 articles in prestigious ISSN journals in USA. She published five books: two books for students, two books on Amazon at International Editor–LAP Lambert Publishing Academic House in Germany- “Sudden Cardiac Death in the Young” and “Side Effects of Antiviral Hepatitis Treatment”, one monograph: “High blood pressure in the young a ignored problem!”, two chapter books – Cardiovascular disease: Causes, Risks, Management CVD1- Causes of Cardiovascular Disease 1.5, 1.6, USA on Amazon. , a book in USA –“Tumor Markers in Hypertensive Young Patients”.
