Case Report
Preoperative Diagnosis of Hyperneproma in a Renal Cyst Wall by Selective Renal Angiography
Abstract
THE ACTUAL INCIDENCE of a tumor within or adjacent to a renal cyst wall is difficult to establish and therefore controversial. It is widely thought, however, that the association of renal cysts and neoplasms is higher than could be explained by mere coincidence. Several theories therefore have been advanced linking these two entities in a causative relationship. Two theories are most intriguing. The first contends that the cyst is the end stage of a spontaneously healed tumor.1–4 The other widely accepted theory was advanced by Hepler5 45 years ago. He showed experimentally that tubular blockage and ischemia in the same part of the kidney will result in cyst formation distally. A tumor undoubtedly could have this double effect. This theory neatly explains the fact that most tumors associated with cysts are found at the base of the cyst adjacent to the renal parenchyma.Many of those cases reported in the literature displayed a thick, irregular cyst wall, hemorrhagic cyst fluid, or other signs suggestive of malignancy, and consequently did not pose a diagnostic problem. However, we found a number of cases in the literature where radiographic criteria, cyst fluid examination, and even surgical exploration and study of frozen sections gave the impression of a benign renal cyst, and only histologic examination of the cyst wall on permanent section revealed tumor cells.2,4,6–11 Of these, only two patients2,11 had a selective renal arteriogram.This content is limited to qualifying members.
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