Use of a molecular approach for the definitive diagnosis of proliferative larval mesocestoidiasis in a cat

Gastrointestinal parasites of cats in the Middle East (2000-2023): A literature review

BACKGROUND/OBJECTIVE

Gastrointestinal parasites in stray cats are of significant clinical and zoonotic importance and pose a potential threat to public health. Hence, the current review has practical implications as it aims to present the diversity and the prevalence of cat parasites in Middle Eastern countries.

METHODS

The research process was rigorous and thorough, spanning from 2000 to 2023. Data collection and analysis were conducted utilizing multiple international and national databases, including Google Scholar, Scopus, PubMed, and Irandoc. This meticulous approach ensures the reliability and validity of the findings, providing a solid foundation for further research and preventive measures.

RESULTS

A total of 159 articles were collected and comprehensively reviewed. Among these, 85 articles were from Iran, 25 from Türkiye, 20 from Iraq, 11 from Egypt, five from Qatar, three from Cyprus, three from Kuwait, and one each from the UAE, Saudi Arabia, Syria, Lebanon, Jordan, Israel, and Palestine. Toxocara cati was the most prevalent nematode, exhibiting the highest prevalence in Iran, ranging from 8% to 90%, followed by Egypt, with a range of 8.23% to 58.7%. In comparison, the lowest prevalence was recorded in Qatar at 8%. Hydatigera taeniaeformis, a common cestode in the feline, showed the highest prevalence in Qatar, with a range of 73.6% to 75.8%, while the lowest was in Kuwait at 0.8%. In Iran, the prevalence ranged from 0.9% to 64.7%. Toxoplasma gondii, a cosmopolitan protozoan, showcased the highest prevalence in Lebanon at 78.1% and the lowest in the UAE at 0.8%. In Iran, the prevalence ranged between 1.2% and 90%. Additionally, noteworthy patterns regarding the distribution and potential risk factors associated with these parasites were observed. While gender variations were not significant, environmental conditions such as high humidity and absence of sunlight exposure, along with the age and behavior of cats, were among the risk factors associated with the prevalence of parasites.

CONCLUSION

The prevalence of parasites among stray cats in Iran and other Middle Eastern countries remains notably high. This emphasizes the urgent need for a series of control and preventive measures. Implementing effective anti-parasitic strategies and emphasizing the development of multiple diagnostic methods are essential.

Wood mouse (Apodemus sylvaticus L.) as intermediate host for Mesocestoides canislagopodis (Rudolphi, 1810) (Krabbe 1865) in Iceland

Mesocestoides canislagopodis is a common parasite of the arctic fox (Vulpes lagopus) in Iceland. In the past, household dogs (Canis familiaris) and cats (Felis catus) were also reported in Iceland to be infected. Recently, scolices of a non-maturing Mesocestoides sp. were detected in the intestines of the gyrfalcon (Falco rusticolus), and tetrathyridia were isolated in the body cavity of rock ptarmigan (Lagopus muta) and subsequently described. All stages were confirmed, using both morphological and molecular methods, to belong to the same species, M. canislagopodis. In the present study, post-mortem examination of wood mice (Apodemus sylvaticus), sampled in autumn 2014 on a farm in Northeast Iceland, revealed the presence of tetrathyridia in the peritoneal cavity and in the liver. Most tetrathyridia in the peritoneal cavity were free, but some were encapsulated in a thin connective tissue stroma and loosely attached to the inner organs. They appear as whitish, heart-shaped, flattened, unsegmented bodies with a slightly pointed posterior end. In the liver, tetrathyridia were seen as pale-tanned nodules embedded in the parenchyma. Comparative molecular analysis, both at the generic level (D1 domain LSU ribosomal DNA), and at the specific level (cytochrome c oxidase subunit I (cox1) and 12S mitochondrial DNA), revealed that the tetrathyridia belonged to M. canislagopodis. A. sylvaticus represents a new second intermediate host record in Iceland, and the first description of a rodent as intermediate host for this species, thus participating in the life cycle of the parasite.

Squamata reptiles as a potential source of helminth infections when preyed on by companion animals

BACKGROUND

Squamate reptiles cohabiting with companion animals may represent a source of helminth infections, especially through predation by dogs and cats with an outdoor lifestyle.

METHODS

In order to assess the role of reptiles as intermediate/paratenic hosts of trophically transmitted helminths, synanthropic reptiles (n = 245) captured from different ecological settings (i.e., households, dog shelters, urban, peri-urban and rural areas or natural parks) of southern Italy were examined for endoparasites. Parasitic cysts (i.e., larval forms of acanthocephalans, cestodes and nematodes) and free helminths (i.e., adult nematodes and digeneans) were morphologically and molecularly identified, and statistical analysis was carried out to evaluate the correlations between reptiles, infections, and ecological settings.

RESULTS

Overall, 31% of reptiles were positive for at least one helminth, with Podarcis siculus (18.7%) and Tarentola mauritanica (8.1%) being the most frequently infected species. Among the parasites of medical interest, Joyeuxiella echinorhyncoides showed the highest prevalence (19.7%), followed by Diplopylidium acanthotetra (10.5%), Joyeuxiella pasqualei, Mesocestoides lineatus (5.6%) and Physaloptera sp. (3.9%). Macracanthorhynchus hirudinaceus was detected once. Podarcis siculus and T. mauritanica were associated with cestode infections.

CONCLUSIONS

The wide range of helminths detected here in reptiles living in sympatry with pets and the fact that many of these helminth species are parasitic and may infect companion animals (e.g., J. pasqualei, J. echinorhyncoides, D. acanthotetra, Physaloptera sp.) and humans (i.e., Macracanthorhynchus hirudinaceus, Mesocestoides lineatus) indicate the potential health risk associated with pets preying on these small vertebrates. Our results indicate the need for complementary investigations of trophically transmitted parasites in dogs and cats living in sympatry with reptiles.

Molecular Characterization of Mesocestoides litteratus (Cestoda: Cyclophyllidea: Mesocestoididae) Tetrathyridium Isolated from Two Species of Rodents from Iran

PURPOSE

Mesocestoides spp. are Cyclophyllidean tapeworms with zoonotic importance. The current study aimed to investigate the molecular characteristics of Mesocestoides larvae (tetrathyridium) isolated from the abdominal cavity of persion jird, Meriones persicus, and from the liver of grey hamster, Cricetulus migratorius, in Ardabil Province, northwest Iran.

METHODS

Genomic DNA of the isolates of Mesocestoides tetrathyridium were extracted, and mitochondrial gene of cytochrome-c oxidase subunit1 (cox1) was amplified. Sequencing of PCR products were performed and phylogenic analysis was run using MEGA 6.0 software.

RESULTS

Both isolates were identified as Mesocestoides litteratus, showing high identity with M. litteratus sequences available in GenBank. Also, they had 100% homology to each other. Intra-species variation within isolates of M. litteratus were 0-2.4%. The phylogenetic reconstruction based on the partial sequence of the cox1 gene showed that our sequences of M. litteratus were clustered with M. litteratus isolates from Slovakia, Netherlands, Germany and Italy.

CONCLUSION

This is the first molecular description of M. litteratus from M. persicus and C. migratorius. Phylogenetic analysis illustrated that M. litteratus isolates of the current study had very high identities with the isolates of this species from other countries.

Successful treatment of pleural and peritoneal larval mesocestoidosis with fenbendazole in two dogs

Mesocestoides spp. are common intestinal tapeworms of dogs and cats. The presence of numerous larval stages in the pleural or peritoneal cavities causes larval mesocestoidosis, that is a potentially life-threatening disease in massive infection. In vivo diagnosis of larval mesocestoidosis is challenging and confirmed diagnosis is often made post-mortem. For this reason, therapeutic recommendations are empirical and there is currently no data on the best treatment options in dogs and cats. Both fenbendazole and praziquantel have been used to treat canine larval mesocestoidosis but failure of complete clearance of larvae has been described for both. Treatment with fenbendazole at 100 mg/kg orally twice a day, for 1-3 months has been reported as being effective. However, it is known that administration of high, off-label doses of fenbendazole can lead to adverse reactions. Here, we report the efficacy of fenbendazole at a lower dosage (50 mg/kg twice a day) in two dogs with pleural and peritoneal mesocestoidosis.

Biological responses in pesticide exposed lizards (Podarcis siculus)

The release of contaminants as herbicides, fungicides and insecticides into the environment has been listed as one of the six major contributors to the global decline of reptiles. Although reptiles may face severe risk from contaminants due to their ecology and physiology, they are currently less studied than other vertebrate groups. In the present work, we investigated if and how different types of field treatment (conventional and organic) affected the health status of Italian wall lizard (Podarcis siculus) individuals in central Italy. We chose a multi-biomarker approach that evaluated the biological responses of lizards to the treatment by means of AChE activity in the nervous system, biotransformation enzymes activities and oxidative stress in the liver, micronuclei frequency measured in the erythrocytes, and rate of intestinal parasitic infection. Our findings showed evidence of effects of treatment in conventional areas and between sexes with significant oxidative stress due to hydroxyl radicals, that caused DNA damage. No difference of intestinal parasite infections was found among treatments. Podarcis siculus seems to be a good bioindicator in ecotoxicological studies and potentially in risk assessment of pesticides, although further analyses in laboratory and in the field are needed to achieve more accurate quantification of specific pesticide effects in relation to known exposure history and to understand if other mechanisms were involved in the toxicity and detoxification process of pesticides for this species.

The typical cestodes of the red fox in eastern areas of the Iberian Peninsula have a grouped distribution

The red fox (Vulpes vulpes) is the most abundant wild canid in the Iberian Peninsula, and can act as a carrier of a wide range of parasite species shared with dogs and cats and which are sometimes zoonoses. Despite this, few studies are available describing the distribution and epidemiology of the cestode community of this opportunistic carnivore in areas of Mediterranean climate. In this study, prevalence, intensity, abundance and aggregation coefficient of cestodes found in 286 red foxes of the Valencian Community (East Spain) were calculated. For the most prevalent species, presence data were combined with environmental variables in order to build spatial models and predict the limiting factors associated with the decrease of suitable habitat for these parasites. The overall prevalence of cestodes was 83.22 % (238/286). Specifically, foxes harboured Mesocestoides spp. (75.87 %), Joyeuxiella echinorhynchoides (27.62 %), Taenia pisiformis (13.29 %), Dypilidium caninum (3.15 %), Taenia polyacantha (1.05 %), Taenia hydatigena (0.70 %), Taenia crassiceps (0.70 %) and Taenia spp. (0.35 %). Tetrathyridia larvae were found both in thoracic and abdominal cavity of three foxes (1.05 %), being the first time that this metacestode stage is described in the thoracic cavity of the red fox. Models on Mesocestoides spp. (Area Under the Curve, AUC = 0.80) and J. echinorhynchoides (AUC = 0.83) indicate that anthropogenic, climatic and environmental factors efficiently describe the habitat shape of parasites. This study emphasizes that foxes in Mediterranean areas are hosts of cestodes of veterinary and public health concern. Furthermore, our results demonstrate the usefulness of Ecological Niche Modeling applications for mapping the distribution of fox parasites and identifying areas of higher epidemiological risk for this wild canid, as well as for dogs and cats and, in the case of Mesocestoides spp., for humans.

First molecular identification of the tapeworm Mesocestoides litteratus from an Italian wall lizard (Podarcis siculus)

The cyclophyllidean cestodes of the genus Mesocestoides are parasites infecting a variety of carnivorous vertebrates. The complete life cycle of these tapeworms is not clear yet, but some reptiles, amphibians, birds and micro-mammals have been indicated as intermediate hosts. Although Mesocestoides spp. are considered endemic in Europe, infections by the metacestode form, the tetrathyridium, are reported less commonly than are infections by adult worms. In the present study, a peritoneal infection by Mesocestoides tetrathyridia in a wall lizard (Podarcis siculus) collected in central Italy is described. The phylogenetic position of the metacestodes was assessed using the barcode region COI and species delimitation methods, i.e. Automatic Barcode Gap Discovery (ABGD) and Bayesian implementation of the Poisson Tree Processes model (bPTP). COI sequence analysis assigned the isolates from the wall lizard to Mesocestoides litteratus, as confirmed by species delimitation and phylogenetic analyses. M. litteratus has been observed in Europe mainly in the definitive hosts (dogs, cats and foxes), and never identified in the Mediterranean region. This study represents the first evidence of parasitic infection by tetrathyridia of M. litteratus in P. siculus in Italy.

Molecular identification of Taenia hydatigena and Mesocestoides species based on copro-DNA analysis of wild carnivores in Mongolia

Cyclophyllidean tapeworms obligatorily parasitize numerous mammalian species, including herbivores, domestic animals and humans, of which, the genera Taenia and Mesocestoides are well characterized. However, little is known about these parasitic infections in wild animals. This study aims to investigate the prevalence and distribution of Taenia sp. and Mesocestoides sp. in wild carnivores in Mongolia by identifying tapeworm species based on mtDNA analysis. The field survey was carried out in 2012–2013 in 19 provinces located in different ecological regions. A total of 405 fecal samples from wild carnivores were collected. Specific DNA markers in fecal samples was detected via copro-DNA analysis and tapeworm species were identified by DNA sequencing. From 27.7% (112/405) of samples, cox1 and 12S rRNA genes of tapeworms were amplified. Further, Taenia hydatigena (50.0%, 56/112) and two Mesocestoides species, including Mesocestoides sp.-1 (36.6%, 41/112) and Mesocestoides sp.-2 (13.4%, 15/112) were identified by DNA sequencing. The prevalence of T. hydatigena was 19.9% (27/136), 13.8% (23/167), 4.8% (3/62), and 7.5% (3/40) in wolves, red foxes, corsac foxes, and snow leopards, respectively. The prevalence of Mesocestoides sp.-1 was 14.7% (20/136), 9% (15/167), 9.7% (6/62) in wolves, red foxes, and corsac foxes, while the prevalence of Mesocestoides sp.-2 was 4.4% (6/136), 1.8% (3/167), 3.2% (2/62), and 10.0% (4/40) in wolves, red foxes, corsac foxes, and snow leopards, respectively. T. hydatigena was found throughout all ecological regions, while Mesocestoides sp.-1 was in the mountain taiga, forest-steppe, steppe, desert-steppe, and desert, and Mesocestoides sp.-2 in the alpine, forest-steppe, steppe, and desert-steppe ecoregions. This study revealed the prevalence and distribution of cyclophyllidean tapeworms in wild carnivores in Mongolia; while also confirming that wolves, red foxes, corsac foxes, and snow leopards serve as definitive hosts for unidentified Mesocestoides species.

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Taenia hydatigena and two Mesocestoides species were first identified by copro-DNA analysis in wild carnivores in Mongolia.

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The persistent infections by T. hydatigena and Mesocestoides species in these animals were shown.

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T. hydatigena was detected in all ecoregions in Mongolia.

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Mesocestoides sp.-1 was found in wild carnivores inhabiting in all ecoregion unless in the alpine, and Mesocestoides sp.-2 in the alpine, forest-steppe, steppe, and desert-steppe ecoregions.

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Wolf, red fox, corsac fox, and snow leopard were confirmed as definitive hosts for Mesocestoides species.

Massive infection of a song thrush by Mesocestoides sp. (Cestoda) tetrathyridia that genetically match acephalic metacestodes causing lethal peritoneal larval cestodiasis in domesticated mammals

Background

Peritoneal larval cestodiasis induced by Mesocestoides Vaillant, 1863 (Cyclophyllidea: Mesocestoididae) is a common cause of severe infections in domestic dogs and cats, reported also from other mammals and less frequently from birds. However, there is a limited knowledge on the taxonomy of causative agents of this disease.

Results

In the present study, we investigated a massive, likely lethal, infection of a song thrush Turdus philomelos (Passeriformes: Turdidae) by Mesocestoides sp. tetrathyridia. We performed combined morphological and phylogenetic analysis of the tetrathyridia and compared them with the materials obtained previously from other birds and mammals. The metrical data fitted within the wide range reported by previous authors but confirmed the limited value of morphological data for species identification of tetrathyridia of Mesocestoides spp. The molecular analyses suggested that the isolates represented an unidentified Mesocestoides sp. that was previously repeatedly isolated and sequenced in larval and adult forms from domestic dogs and cats in Europe, the Middle East and North Africa. In contrast to the present study, which found encysted tetrathyridia, four of the five previous studies that identified the same species described infections by acephalic metacestodes only.

Conclusions

The tetrathyridia of the examined Mesocestoides sp. are described in the present study for the first time. However, the possible match with the species that were previously reported to infect birds remains uncertain. The phylogenetic analyses also suggested the rejection of two cases that were previously identified as Mesocestoides corti as they were likely caused by the same species as in the presently reported infection case. The newly provided DNA sequences should allow the assignment to species in the future, when adults of the genus Mesocestoides are more thoroughly sequenced.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3480-1) contains supplementary material, which is available to authorized users.

Species delimitation based on mtDNA genes suggests the occurrence of new species of Mesocestoides in the Mediterranean region

BACKGROUND

This study is the first contribution to the molecular taxonomy of Mesocestoides spp. from domestic and wild carnivores in the Mediterranean area. A total of 13 adult worms and 13 larval stages of Mesocestoides spp. were collected from domestic and wild carnivore hosts in Italy and Tunisia. Samples collected in the Slovak Republic were used as comparative samples from outside the Mediterranean. The genes cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit 1 (nad1) of the mitochondrial genome were used as molecular markers to investigate the presence of cryptic Mesocestoides species in the area analysed.

RESULTS

Results were consistent in showing three well-supported clusters of Mesocestoides spp. in southern Italy and Tunisia, which were strongly divergent from Mesocestoides litteratus, M. corti and M. lineatus. High levels of genetic variation and no evidence of geographical structuring was found between the clusters.

CONCLUSIONS

Considering the low dispersal capability of the intermediate hosts of Mesocestoides spp., the lack of geographical structuring among the Mediterranean regions could be due to a high potential for dispersion of the definitive hosts. This study provides a foundation for future formal descriptions of new species of the genus Mesocestoides in the Mediterranean area.

Differential Effects of the Flavonolignans Silybin, Silychristin and 2,3-Dehydrosilybin on Mesocestoides vogae Larvae (Cestoda) under Hypoxic and Aerobic In Vitro Conditions

Mesocestoides vogae larvae represent a suitable model for evaluating the larvicidal potential of various compounds. In this study we investigated the in vitro effects of three natural flavonolignans—silybin (SB), 2,3-dehydrosilybin (DHSB) and silychristin (SCH)—on M. vogae larvae at concentrations of 5 and 50 μM under aerobic and hypoxic conditions for 72 h. With both kinds of treatment, the viability and motility of larvae remained unchanged, metabolic activity, neutral red uptake and concentrations of neutral lipids were reduced, in contrast with a significantly elevated glucose content. Incubation conditions modified the effects of individual FLs depending on their concentration. Under both sets of conditions, SB and SCH suppressed metabolic activity, the concentration of glucose, lipids and partially motility more at 50 μM, but neutral red uptake was elevated. DHSB exerted larvicidal activity and affected motility and neutral lipid concentrations differently depending on the cultivation conditions, whereas it decreased glucose concentration. DHSB at the 50 μM concentration caused irreversible morphological alterations along with damage to the microvillus surface of larvae, which was accompanied by unregulated neutral red uptake. In conclusion, SB and SCH suppressed mitochondrial functions and energy stores, inducing a physiological misbalance, whereas DHSB exhibited a direct larvicidal effect due to damage to the tegument and complete disruption of larval physiology and metabolism.

Molecular identification of Mesocestoides sp. metacestodes in a captive gold-handed tamarin (Saguinus midas)

Mesocestoides spp. are tapeworms harbored in the intestine of many domestic and wild carnivores, birds of prey and, rarely, of humans. The life cycle is assumed to involve three hosts and the metacestode juvenile stage (tetrathyridium) may reproduce asexually, provoking severe systemic infections. In the present study, a case of a peritoneal infection by Mesocestoides sp. occurred in a captive gold-handed tamarin (Saguinus midas) is described. Phylogenetic positions based on CO1 and 12S loci were analysed to describe in details this unusual finding of Mesocestoides in a callitrichid monkey. The phylogenetic analyses has not clearly resolve relationships between the metacestode forms from the tamarin and any of the described Mesocestoides species available so far, including those described from non-human primates, thus supporting the hypothesis of a new taxon within the genus.

Occurrence of Mesocestoides canislagopodis (Rudolphi, 1810) (Krabbe, 1865) in mammals and birds in Iceland and its molecular discrimination within the Mesocestoides species complex

The life cycle of Mesocestoides tapeworms (Cestoda: Cyclophyllidea: Mesocestoididae) requires three hosts. The first intermediate host is unknown but believed to be an arthropod. The second intermediate host is a vertebrate. The primary definitive host is a carnivore mammal, or a bird of prey, that eats the tetrathyridium-infected second intermediate host. One representative of the genus, Mesocestoides canislagopodis, has been reported from Iceland. It is common in the arctic fox (Vulpes lagopus) and has also been detected in domestic dogs (Canis familiaris) and cats (Felis domestica). Recently, scolices of a non-maturing Mesocestoides sp. have also been detected in gyrfalcon (Falco rusticolus) intestines, and tetrathyridia in the body cavity of rock ptarmigan (Lagopus muta). We examined the taxonomic relationship of Mesocestoides from arctic fox, gyrfalcon, and rock ptarmigan using molecular methods, both at the generic level (D1 domain LSU ribosomal DNA) and at the specific level (cytochrome c oxidase subunit I (COI) and 12S mitochondrial DNA). All stages belonged to Mesocestoides canislagopodis. Phylogenetic analysis of the combined 12S-COI at the specific level confirmed that M. canislagopodis forms a distinct clade, well separated from three other recognized representatives of the genus, M. litteratus, M. lineatus, and M. corti/vogae. This is the first molecular description of this species. The rock ptarmigan is a new second intermediate host record, and the gyrfalcon a new primary definitive host record. However, the adult stage seemed not to be able to mature in the gyrfalcon, and successful development is probably restricted to mammalian hosts.

[Canine peritoneal larval cestodosis caused by Mesocestoides spp. larval stages]

In a female dog with unspecific clinical symptoms, sonography detected a hyperechoic mass in the middle abdomen and blood analysis a middle grade systemic inflammatory reaction. Laparotomy revealed a peritoneal larval cestodosis (PLC). The diagnosis of an infection with tetrathyridia of Mesocestoides spp. was confirmed by parasitological examination and molecularbiological analysis. Reduction of the intra-abdominal parasitic load as well as a high dose administration of fenbendazole over 3 months led to a successful treatment which could be documented sonographically and by decreased concentrations of C-reactive protein (CRP). Seven months after discontinuation of fenbendazole administration, PLC recurred, pre-empted by an elevation of serum CRP values. According to the literature a life-long fenbendazole treatment was initiated. In cases of unclear chronic granulomatous inflammations in the abdominal cavity in dogs, PLC should be considered. CRP concentration and sonographic examinations are suitable to control for treatment success and a possibly occurring relapse.

Tetrathyridiosis in a domestic shorthair cat

CASE SUMMARY

This report describes the clinical and parasitological findings in a domestic shorthair cat with isolated thoracic tetrathyridiosis. The cat was a stray from Malta that had lived in Germany for several years since as an indoor-only cat. Therefore, the process of infection remains very unusual. In this case it must be considered that the cat had been infected years previously while in Malta, and had lived at least 4 years without any clinical signs. It was possible to diagnose this uncommon disease and initiate an effective treatment with fenbendazole, praziquantel and supportive care. Clinical signs, as well as radiographic findings, were regressive with this treatment.

RELEVANCE AND NOVEL INFORMATION

Tetrathyridiosis is a rare finding in cats, especially in Germany, but it seems to be a potential differential diagnosis of pleural effusion. Mesocestoides corti, which was the causative parasite in this case, has not previously been isolated in Germany. Because tetrathyridiosis is only diagnosed post mortem in most cases, little is known about effective therapeutic options. Furthermore, clinical signs of this disease can be absent for several years and can potentially be triggered by neoplastic conditions or immunosuppression. Tetrathyridiosis seems to be a treatable disease that can be controlled by adequate antiparasitic therapy.

The human Bosniak model applied to a cat with renal cystadenoma. A classification to differentiate benign and malignant cystic renal masses via computed tomography and ultrasound

A 13-year-old domestic shorthair cat was presented with weight loss and azotemia. Abdominal ultrasound revealed a large cystic space- occupying lesion with multiple septae in the left kidney. A core needle biopsy yielded a renal cystadenoma originating from the epithelial cells. This report describes the clinical, ultrasonographic and computed tomographic features and the growth progression of a renal cystadenoma. We describe the first attempt to apply the human Bosniak classification to a cat with renal cystic neoplasia to differentiate between benign and malignant lesions. Cystadenoma should be a differential diagnosis in cases of renal cystic space-occupying lesions. Other differentials, imaging features to differentiate benign and malignant lesions and the risk of malignant transformation will be discussed.