Renal hydatid cyst mimicking malignancy: a case report

Hydatid disease, caused by Echinococcus granulosus, primarily affects the liver and lungs, with renal involvement being rare. Renal hydatid cysts are often misdiagnosed as malignancies due to their cystic nature and similar imaging characteristics. Misdiagnosis can lead to inappropriate treatment, making it crucial to include hydatid disease in the differential diagnosis of renal cystic lesions, especially in endemic regions. Early detection, accurate diagnosis, and timely management are essential for preventing complications and achieving favorable outcomes.

We present the case of a 59-year-old woman with right flank pain and gross hematuria. Imaging, including ultrasound and a contrast-enhanced CT scan, revealed a large cystic lesion with calcifications in the right kidney, leading to a preliminary diagnosis of malignancy. The patient underwent laparotomic nephrectomy without preoperative medical therapy. Postoperative histopathological examination confirmed the presence of a renal hydatid cyst. Following surgery, the patient was placed on a three-month course of albendazole to prevent recurrence. Six months later, she remained asymptomatic with normal renal function and no evidence of hydatid cysts elsewhere. The patient did not receive preoperative albendazole therapy, which is commonly recommended to prevent cyst dissemination during surgery. In this case, the decision to proceed without preoperative medical therapy was due to the mistaken diagnosis of malignancy. This underscores the importance of considering hydatid cysts in the differential diagnosis before deciding on a surgical approach. The decision to perform a radical nephrectomy was driven by the presumption of renal malignancy. Alternative surgical options, such as cystectomy or conservative surgery, were not considered due to the initial misdiagnosis. Had hydatid disease been suspected, a less aggressive approach aimed at cyst removal and kidney preservation could have been attempted.

Renal hydatid cysts are rare and challenging to diagnose due to their resemblance to renal tumors. Surgical resection is the preferred treatment, especially when malignancy is suspected. This case highlights the importance of postoperative medical therapy to prevent recurrence, as well as the need for histological confirmation to guide appropriate management. Long-term follow-up of 12-24 months is recommended to monitor for recurrence of hydatid disease. In this case, follow-up was limited to six months, which may not be sufficient to entirely exclude the possibility of recurrence.

This case underscores the importance of considering hydatid disease in renal cystic masses, emphasizing early diagnosis, surgical management, and postoperative prophylaxis for optimal outcomes.