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LETTER TO EDITOR
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 139-140

Liesegang rings: An unusual mimicker in renal cyst


1 Department of Pathology, K S Hegde Medical Academy of Nitte University, Mangalore, Karnataka, India
2 Department of Urology, K S Hegde Medical Academy of Nitte University, Mangalore, Karnataka, India

Date of Web Publication26-Jul-2013

Correspondence Address:
Kishan HL Prasad
Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.115694

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How to cite this article:
Bhat SP, Prasad KH, Ravinder P, Hegde P. Liesegang rings: An unusual mimicker in renal cyst. Int J Health Allied Sci 2013;2:139-40

How to cite this URL:
Bhat SP, Prasad KH, Ravinder P, Hegde P. Liesegang rings: An unusual mimicker in renal cyst. Int J Health Allied Sci [serial online] 2013 [cited 2019 Sep 20];2:139-40. Available from: http://www.ijhas.in/text.asp?2013/2/2/139/115694

Sir,

Liesegang rings (LRs) are laminated spherical ring like structures that develop usually in cystic or inflammatory lesions. [1] It is commonly seen in kidney, breast, eye, synovium, omentum, pericardium, pleura, maxillary sinus, epididymis, and  Fallopian tube More Details. These rings have peripheral concentric layer with radial cross striations and central amorphous core. Their size varies from 5 μm to 820 μm in diameter. LRs have been mistaken in histopathology for ova, larvae, adult parasites, foreign material, and calcifications. [2] We bring to your notice this interesting histopathological finding in a 57-year-old male with a simple renal cyst.

A 57-year-old male came with low backache since 1 month. Computerized tomography of the abdomen showed cystic lesion in the mid pole of the left kidney measuring 3.9 cm × 3 cm predominantly affecting the renal cortex [Figure 1]a. Excision of the cystic lesion grossly, was uniloculated with a smooth wall, devoid of solid areas. Histology of the cyst showed cuboidal epithelial lining [Figure 1]b. Cyst wall also showed numerous varying sized eosinophilic spherical lamellated rings such as structures with radial cross striations and amorphous core with foreign body giant cell response [Figure 1]c. These were accentuated by periodic acid schiff [Figure 1]d, Gomorie's methenamine silver stain and was negative for von kossa stain. These findings confirmed the presence of LR in a simple renal cyst.
Figure 1: (a) Computerized tomography of abdomen showing cystic lesion in the mid pole of the left kidney predominantly affecting the renal cortex. (b) Histology of the renal cyst lined by cuboidal epithelium (H and E, ×100). (c) Cyst wall showing Liesegang rings with foreign body giant cell response (H and E, ×400). (d) Liesegang rings with PAS positivity (×400)

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The term LRs is attributed to the Liesegang phenomenon, first described by the German biochemist R. E. Liesegang in 1896. [3],[4] He observed concentric, laminated rings produced in vitro by periodic precipitation of certain chemicals around a central nidus in colloidal gels. LRs are concentric, cellular structures, usually found in the kidney, synovium, conjunctiva, and eyelid. They are found in cysts, fibrotic tissue, hemorrhagic zones, and inflammatory processes in necrotic areas. Most have a double layer outer wall with equally spaced radial cross striations and an amorphous central nidus. [3] The composition of the LR is not fully understood. Immunohistochemical and histochemical stains for calcium (von kossa), iron, mucopolysaccharide, amyloid, glycogen, keratin, and epithelial membrane antigen are negative. Special stains, radiographic analysis or scanning electron microscopy revealed that some LRs contained iron, silicon, and sulfur. [1],[2],[3],[4] According to some, these contain Ca ++ besides other inorganic anions, organic polycations, and organic polyanions. [1],[2],[3] They have been confused with various parasites, algae, calcification, corpora amylacea, psammoma bodies, hyaline globules of adenoid cystic carcinoma, collagenous spherulosis, michaelis-gutman bodies, and the amyloid. Some pathologists have mistaken these for ova, larvae or adults of the giant kidney worm, Dioctophyma renale. The latter is a large blood-red nematode that infects a variety of fish-eating mammals. The adult worms are usually expelled by the urethra. [2],[3],[4] These can be excluded by negative histochemical staining with perls, von kossa, congo red, alcian blue, mucicarmine, and massons trichrome. [2] LRs are distinguished from helminths by their greater variation in size and irregularity of shape. Foreign materials are usually birefringent, whereas LRs are not. In contrast to psammoma bodies, LRs are eosinophilic and are negative for von kossa. [4] LRs are relatively rare structures, usually seen in cystic and inflammatory lesions of kidney. They are commonly mistaken for parasites and psammoma bodies. With the knowledge of morphology and histochemical stains, misdiagnosis can be avoided.

 
  References Top

1.Gavin K, Banville N, Gibbons D, Quinn CM. Liesegang rings in inflammatory breast lesions. J Clin Pathol 2005;58:1343-4.  Back to cited text no. 1
[PUBMED]    
2.Raso DS, Greene WB, Finley JL, Silverman JF. Morphology and pathogenesis of Liesegang rings in cyst aspirates: report of two cases with ancillary studies. Diagn Cytopathol 1998;19(2):116-9.  Back to cited text no. 2
    
3.Pegas KL, Edelweiss MI, Cambruzzi E, Zettler CG. Liesegang rings in xanthogranulomatous pyelonephritis: A case report. Patholog Res Int 2010:1-3.  Back to cited text no. 3
    
4.Santos-Briz A Jr, Serrano R, del Cañizo A, Santos-Briz A, de Agustín PP. Liesegang rings in a dermoid cyst of the floor of the mouth. Report of a case with cytologic findings. Acta Cytol 2000;44:1062-5.  Back to cited text no. 4
    


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