Hydatid cyst of pelvic kidney #FirstofItsKind
The present case has been reported in the journal Urology Case Reports. A 67-year-old woman with a history of hydatid cyst of liver presented complaining of a dull pain followed by occasional passage of small, pearly white grape like structure per urethra during urination for the last 4 months. Physical examination revealed guarding, tenderness and a mobile mass in the right quadrant of abdomen. ELISA test for echinococcus antibodies was positive.

Ultrasonography revealed a multivesicular well defined cystic mass extending from the right retroperitoneum to the pelvis where it appears to be attached to the ectopic pelvic kidney. The liver, spleen and left kidney were normal. CT confirmed the large cyst measuring 15 × 12 cm arising from cortex of upper pole of right ectopic pelvic kidney replacing the renal tissue. The cyst was multivesicular and well-defined with a thin non enhanced wall containing microcalcifications.

The cyst was close to pancreatic uncinate process, the third part of the duodenum and right colonic flexure. The diagnosis of isolated hydatid cyst of ectopic pelvic kidney was made. The abdomen was opened by right Kocher's incision. There was a cystic mass measuring 15 cm which covered the entire kidney. Initially, the hypertonic saline (20% sodium chloride solution) was injected into the cyst and surrounding tissues were protected using gauze soaked in hypertonic saline. After cyst removal, the right kidney parenchyma was completely destroyed.

Gross pathologic examination revealed a large medullar white cyst containing translucent fluid and daughter cysts of varying size. Histopathology study revealed an hydatid cyst with three layers: outermost pericyst is fibrous, middle ectocyst layer is laminated, hyaline and acellular and the inner endocyst is the germinative layer which consists of daughter cysts and brood capsules with scolices.

It's associated to granulomatous foreign body reaction. The adjacent medullary renal parenchyma shows lesions of chronic pyelonephritis. Patient was discharged on postoperative day 3. No signs of recurrence showed after 6 months of follow-up.

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