BENIGN tumours of the kidney very rarely cause any clinical symptoms necessitating surgical interference, but villous papillomata of the renal pelvis and cavernous angiomata of the renal tissue may cause sudden and profuse haematuria which demands operation as an urgent life-saving measure. One of us (R.H.J.S.) reported a case of cavernous angioma of the kidney in 1921, since when other cases have been recorded, though in some the evidence is somewhat doubtful. A second case recently came under our care which is now reported, and an attempt will be made critically to review the cases previously recorded, and also to bring out a few points which may be of assistance in dealing with similar cases.
SURGEON EMERITUS TO THE CANCER HOSPITAL, LONDON
CASE REPORT
C. S. L., aged 15, a schoolboy at a well known Public School, commenced a fairly profuse hnmaturia on the morning of Nov. 2, 1934, unaccompanied by pain, frequency, vesical irritability, or pyrexia. Apart from some chest affection in childhood he had always been a strong and healthy lad, and there had been no previous attack of hnmaturia nor had there been any symptoms attributable to disease of the urinary tract. Three days prior to the onset of hnmaturia, he had sustained a kick in the scrotum whilst playing football, but recovered after a short interval and resumed the game and played a further game without discomfort two days later.
As soon as the hnmorrhage was reported, the boy was put to bed in the College Sanatorium and placed on a bland fluid diet. The temperature and pulse were normal; there was no swelling, no evidence of trauma nor tenderness in either renal angle. Neither kidney could be palpated. The subsequent history of the case and the investigations carried out are best given in chronological order.
Nov. +-Temperature and pulse normal, but hnmaturia persisted. The urine was heavily loaded with red blood-cells with a normal complement of leucocytes. No casts or pus were present, but a number of acid-fast and alcohol-fast bacilli were found in the centrifuged deposit, suggestive of tubercle bacilli. The specimen was not drawn by catheter, but a guinea-pig was inoculated from the deposit. Nov. 7.-Hzematuria still present but in diminished quantity. No rise in temperature or of pulse-rate, and no discomfort nor frequency in micturition. A catheter specimen of urine was examined, but no organisms were present and no pus cells found.
Nov. 10.-Hiematuria now ceased and urine was bright and clear. Slides of the organisms reported on Nov. 4 were submitted to another bacteriologist, who was of opinion that they were not tubercle bacilli but a non-pathogenic streptothrix.
Nov. 14.-Blood examination showed :- Red cells