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CASE REPORT
Year : 2003  |  Volume : 20  |  Issue : 1  |  Page : 59-60
 

Primary papillary mesothelial hyperpla­sia of the renal capsule - an unusual cause of renal calcification


1 Urology Unit, JN Medical College and Radhikabai Meghe Memorial Hospital, Sawangi (Meghe), Wardha, India
2 Department of Surgery, JN Medical College and Radhikabai Meghe Memorial Hospital, Sawangi (Meghe), Wardha, India
3 Department of Pathology, RST Regional Cancer Hospital, Nagpur, India
4 Department of Nephrology, JN Medical College and Radhikabai Meghe Memorial Hospital, Sawangi (Meghe), Wardha, India

Correspondence Address:
Sanjay P Kolte
302, Indradhanu, 188, Cement Road, Shivajinagar, Nagpur - 440 010
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Renal, renal capsule, mesothelial hyperplasia.


How to cite this article:
Kolte SP, Charles N, Moghe G, Choube S. Primary papillary mesothelial hyperpla­sia of the renal capsule - an unusual cause of renal calcification . Indian J Urol 2003;20:59-60

How to cite this URL:
Kolte SP, Charles N, Moghe G, Choube S. Primary papillary mesothelial hyperpla­sia of the renal capsule - an unusual cause of renal calcification . Indian J Urol [serial online] 2003 [cited 2020 Nov 24];20:59-60. Available from: https://www.indianjurol.com/text.asp?2003/20/1/59/37127



   Case Report Top


A 32-year-old female presented with vague right lower abdominal pain since 2 years. She had no gastrointestinal or urinary symptoms or menstrual irregularities. Her rou­tine hematological and biochemical profile was normal. Ultrasonography revealed a hyperechoic mass in the lower pole of the kidney. All the other abdominal viscera were normal. Intravenous pyelography showed a lower polar renal calcification which was porous, triangular in shape and measured 5x4 cm in size. It was away from the pelvicalyceal system (entirely parenchymal) [Figure - 1]. CT scan confirmed the findings of pyelography and the ab­sence of any mass lesion or neovascularisation [Figure - 2]. The patient was operated upon with the clinical diagnosis of tuberculous renal calcification.

On exploration, the calcified mass was seen at the lower pole of kidney. It was bony hard and adherent to the peri­toneum anteriorly. It was excised and the raw renal bed was covered with surrounding Gerota's fascia. The remain­ing kidney was totally normal. The peritoneum did not contain any other focus of granulation or nodules. The patient recovered uneventfully.

The excised specimen measured 4x3x3 cm and had an irregular surface. Histopathological examination revealed a lesion composed of papillary projections with fine fibro­vascular cores. The cells lining the papillae were cuboial with scanty eosinophilic cytoplasm and small central nu­clei. There was dense calcification in the stroma. There were no granulomas.

Immunohistochemical study was carried out using a panel of antibodies comprising cytokeratin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and mesothelioma-associated antigen (All antibod­ies were from Dako A/S, Denmark). The cells lining the papillae were positive for cytokeratin, epithelial membrane antigen and mesothelioma-associated antigen, but were negative for carcinoembryonic antigen. This suggested a mesothelial origin of the lesion and a diagnosis of papil­lary mesothelial hyperplasia was made. The adjoining re­nal tissue showed signs of chronic inflammation.


   Comments Top


Renal calcification is a common entity and the causes are many. Commonest non-calculous cause in India is re­nal tuberculosis. The calcification in renal tuberculosis is lobar in distribution and always associated with a calyc­eal lesion or lies in close proximity to it. It represents a burnt out disease and the indication for surgical removal is to prevent re-activation of the disease and to avoid spread to the remaining renal tissue. The lesion in the present case was intra-parenchymal and not related to the pelvi­calyceal system. Pathologically, the papillary lesion was unlike a renal cell carcinoma. Mesothelial hyperplasia with calcification is known to occur in mesothelial membranes; the pleura and the peritoneum. These calcifications are not large enough to be seen on normal roentgenograms and may be revealed only on CT scans. [1] It is extremely difficult to differentiate this from a mesothelioma on his­topathology alone. [2] In patients with mesothelioma a his­tory of asbestos exposure is commonly present. [3] It is always a generalized process and invariably accompanied by prominent ascitis. Mesothelial hyperplasia as a cause of renal calcification is very rare. In our case, the site of origin was the renal parietes; most probably the renal cap­sule and /or the surrounding fasciae.

 
   References Top

1.Roger G, Wirthington PC. Mesothelioma, current insights. The Cancer Journal. 1994; 7(5).  Back to cited text no. 1    
2.Henderson DW, Shilkin KB, Whitaker D. Reactive mesothelial hy­perplasia vs mesothelioma, including mesothelioma in situ : a brief review. Am J Clin Pathol 1998; 110: 397-404.  Back to cited text no. 2  [PUBMED]  
3.King JA, Tucker JA, Wong SW. Mesothelioma : A study of 22 cases. South Med J 1997; 90: 199-205.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]


    Figures

  [Figure - 1], [Figure - 2]



 

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