Male patient, 68 years old, ex-operator of the textile industry, referred to consultation for complex renal cyst mass.
History of rheumatoid arthritis, controlled hypertension, dyslipidemia, pulmonary tuberculosis for 40 years, treated with indapamide, simvastatin and NSAIDs.
Smoking habits or exposure to chemical agents.
She reported exposure to sheep in youth.
She had a known history of kidney stones.
She underwent left hip replacement for years.
Abdominal or genitourinary ciruía.
She reported elimination of gelatinous material in the urine for months, without specific form, accompanied by episodes of total macroscopic hematuria, without clots.
No other accompanying symptoms such as back pain, nausea or vomiting, or lower urinary complaints
No anorexia, asthenia or weight decrease.
No respiratory or gastrointestinal symptoms.
On physical examination, the patient presented non-painful crushing of the flank/left lumbar region.
No hepatomegaly, no abnormal abdominal collateral circulation.
Genital without clinical varicocele.
Lower limbs without edema.
No peripheral lymphadenopathy.
Pulmonary auscultation was normal.
Laboratory thermography showed mild anemia (Hb 12.7 g/dL), without leukocytosis.
Relative eosinophilia (2800/μL).
SV 67 mm. Creatinine 1.2 mg/dL.
Urea 77 mg/dL.
An ultrasound revealed a right kidney with slightly reduced dimensions (10.8 cm) and increased echogenicity of the parenchyma, presenting a simple cyst in the upper pole.
The left kidney was a complex voicing cyst of the upper pole (70 x 68 x 67 mm), with evident solid content and regions associated with posterior acoustic shadowing.
Subjected to CAT scan, the apex-fieldpelvic - voicing complex cystic formation units contained parietal and central grosar calcifications, occupying the upper two thirds of the kidney, and the interior 20 House varied its septa.
After contrast administration, there is evidence of uptake by the walls.
No lesions of solid abdominal organs, presence of retroperitoneal lymphadenopathies or morphological alteration of the adrenal gland were evident.
Chest radiography showed no significant alterations, such as cystic lesions or alterations compatible with metastatic lesions or active tuberculosis.
Mantoux (Tuberculin test) negative.
Search negative acid-fast bacilli.
Urine cultures (multiple samples) were negative on Lowenstein mean.
Serology for Echinococci granulosis and multilocularis negative.
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With the diagnosis of complex cystic mass Bosniak class IV and in the absence of support for specific/parasitic infectious lesions, he underwent left radical nephrectomy by incision of lumbotomy on the bed of the 12th rib.
The anatomopathological examination showed neoplasia of 11.5 cm of bigger dimension, constituted by glands of simple and complex structure, being the epithelium moderately differentiated and centered by mucoid material in the form of large "pools" of mucin.
The lesion is located in the renal parenchyma without affecting the capsule.
The remaining parenchyma showed signs of mild pyelonephritis.
Tumor-free surgical margins.
Conclusion: mucinous adenocarcinoma of the renal pelvis PT3NxMx.
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After obtaining the histological result, the patient underwent upper gastrointestinal endoscopy and showed no abnormalities.
Follow-up was 10 months.
The patient is completely asymptomatic, with no evidence of disease recurrence, locally or distantly.
