Surgical Management of Retroperitoneal Cystic Lesion in a Solitary Kidney Patient

A 64-year-old female, with a history of right nephrectomy for pyonephrosis ten years ago, developed pain in her left flank. A CT scan revealed a cystic lesion in the retroperitoneum abutting the tail of the pancreas and adherent to the left renal vein, raising concerns of either a cystic neoplasm of the pancreas or an adrenal tumor. Referred to us due to her solitary kidney and the tumor’s proximity to the renal vein, we conducted metanephrine level tests which were normal, ruling out a functional tumor. During surgery, we encountered adhesions from her previous operation and identified a cystic lesion arising from the adrenal gland and adhering to the left renal vein. We carefully dissected it off the renal vein, tying off all large branches from the renal vessels, and successfully removed the tumor, preserving the kidney. The postoperative course was uneventful, and histopathology confirmed the lesion as an oncocytic variant of pheochromocytoma.

Surgical Management of Retroperitoneal Cystic Lesion in a Solitary Kidney Patient

Patient Profile:

  • Age: 64 years
  • Gender: Female

Medical History:

  • Right nephrectomy for pyonephrosis 10 years ago

Clinical Presentation:

  • Developed pain in the left flank

Diagnostic Imaging:

  • CT scan showed a cystic lesion in the retroperitoneum abutting the tail of the pancreas and adherent to the left renal vein, suggesting either a cystic neoplasm of the pancreas or an adrenal tumor.

Referral and Preoperative Workup:

  • Referred to us due to the complexity of the case involving a solitary kidney and the tumor’s proximity to the renal vein.
  • Metanephrine levels were normal, ruling out a functional tumor.

Surgical Intervention:

  • During surgery, we released adhesions from the previous surgery.
  • Identified a cystic lesion arising from the adrenal gland, adherent to the left renal vein.
  • Dissected the lesion off the renal vein, tying off all large branches supplying it from the renal vessels.
  • Successfully removed the cystic lesion while preserving the kidney.

Postoperative Course:

  • Uneventful recovery.

Histopathology Report (HPR):

  • Oncocytic variant of pheochromocytoma.