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Answer: D. Renal lymphoma. Although cystic presentation has been reported, it is highly unusual.
After additional laboratory evaluation, left nephrectomy was performed.
Specimen photograph shows a large cyst arising from the left kidney containing multiple smooth-walled daughter cysts.
Diagnosis: Renal Hydatid Disease
- Hydatid disease is a worldwide zoonosis caused by the larval stage of the Echinococcus tapeworm, primarily E granulosus.
- Endemic to many sheep- and cattle-raising regions of the world (Mediterranean, Africa, South America, the Middle East).
- Life cycle involves two hosts: the definitive host, usually a dog or other carnivore, and the intermediate host, most commonly sheep.
- Humans may become intermediate hosts by ingestion of contaminated food or water.
- The liver (75%) and lung (15%) are the most commonly affected organs.
- Renal hydatid disease is rare (2-3% of cases).
- Imaging appearances vary and may include 1) a unilocular cyst without internal architecture in the initial stages, 2) a cyst with multiple daughter cysts, or 3) a completely calcified cyst representing the death of the parasite.
- Immunodiagnostic tests can be helpful in the diagnosis.
- Treatment is primarily surgical, consisting of total or partial nephrectomy.
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