Multilocular cystic renal adenocarcinoma: a case report and review of the literature

Complicated variation of simple renal cyst usually means malignancy: results from a cohort study

BACKGROUND

Currently, simple renal cysts (SRCs) are not considered to warrant follow-up or specific treatment unless a patient presents symptomatically. By demonstrating malignant transformation of SRCs, we urge regular follow-up and timely surgical treatment in affected patients.

METHODS

From September 2002 to September 2010, we treated 31 cases of renal cell carcinoma derived from SRCs. Among these patients, in 14 cases a SRC was radiographically detected by computed tomography (CT) or magnetic resonance imaging (MRI) prior to operation, and malignant tumors were detected by pathological analysis following laparoscopic cyst decortication; 13 of these patients received supplementary radical nephrectomy within 2 months, whereas one patient chose to receive active surveillance. The other 17 patients exhibited SRCs and were monitored by ultrasound for over 6 months; surgical treatment was chosen if a complicated variation of SRCs was found during surveillance, detected by ultrasound, and confirmed by CT or MRI. Median follow-up was 60 months (30 to 126 months). All data analyzed were collected with informed consent, and the study was approved by the ethical committee of our institute.

RESULTS

Pathological studies confirmed early-stage clear-cell renal cell carcinoma in all of the cases, with Fuhrman grade I to III. In decortication-detected malignancies, supplementary radical nephrectomy exhibited residual tumor in 7 out of 13 cases; the patient who chose active surveillance remains free of recurrence for 78 months, and all other patients survived without disease at the last follow-up.

CONCLUSIONS

Renal cell carcinoma may be detected incidentally in SRCs, and more attention should be paid to complicated variations of SRCs during surveillance, owing to the extremely high probability of malignancy. This interesting but alarming phenomenon might urge regular follow-up and timely surgical treatment in affected patients.

The diagnostic dilemma of a multilocular renal cyst: a case report

Introduction

Renal cysts presenting in childhood are rare. Historically, renal cysts have been subject to variable nomenclature which has contributed to diagnostic difficulties. They can occur as solitary, unilateral or multiple lesions. Cysts can be further classified according to loculation, communications within the structure and tissue types present.

Case presentation

We report the case of a 15-month-old Caucasian boy presenting with abdominal distension as the only clinical symptom. On examination, an ill-defined abdominal mass was found. This was confirmed on ultrasound to be a multiseptated cystic mass with a solid element, arising from the right side of the abdomen. Despite further imaging, the origin of the mass could not be identified. The mass was suspected of malignancy but all blood tests and tumour markers were normal. The mass proved to be a diagnostic challenge. The renal origin of the mass was only confirmed at surgery.

Conclusion

Imaging appears to be unreliable in differentiating benign cysts from malignant renal tumours, raising a diagnostic dilemma where surgery seems the only way to reliably establish aetiology of the mass.

Renal cystic neoplasms and renal neoplasms associated with cystic renal diseases: pathogenetic and molecular links

Cystic renal neoplasms represent an isolated cystic mass not accompanied by cystic change of the renal parenchyma. Although cystic change may be seen in any type of renal neoplasm, a few (i.e., cystic renal cell carcinoma, cystic nephroma, cystic partially differentiated nephroblastoma, mixed epithelial and stromal tumor) are characterized by constant cystic change that may involve the entire tumor. Cystic kidney disease is characterized by cystic change, which usually involves the kidneys in a bilateral and diffuse pattern, does not create a discreet mass, and is due to hereditary or developmental conditions. Some of the cystic kidney diseases are not known to give rise to renal neoplasm; others such as autosomal polycystic kidney disease or multicystic dysplastic kidney may fortuitously coexist with renal neoplasms. Three conditions (acquired cystic kidney disease, tuberous sclerosis, and von Hippel-Lindau disease) are associated with renal neoplasms with such a high frequency that they are considered preneoplastic. This article reviews the differential diagnoses among cystic neoplasms. It also focuses on the underlying genetic and molecular mechanisms for the relationship between cystic renal diseases and renal neoplasms.

Adenocarcinoma renale in cisti renale multiloculare. A proposito di 2 rari casi trattati con terapia chirurgica conservativa: Adenocarcinoma in multilocular renal cyst. A report of 2 cases treated with conservative surgery

The Authors present the surgical approach and the management of two new cases of adenocarcinoma in multilocular renal cyst treated with conservative surgery. The pathological and clinical findings are presented and the difficulty in differentiating benign versus malignant lesions is discussed.

Multiloculated renal cell carcinoma

Multiloculated renal cell carcinoma and multilocular renal cyst with renal cell carcinoma are uncommon diseases. We report on 2 cases of multiloculated renal cell carcinoma. To our knowledge 16 cases of multiloculated renal cell carcinoma and multilocular renal cyst with renal cell carcinoma have been previously described in detail. The authors review the literature and discuss the aetiology and diagnosis of the disease.

Multilocular cysts of kidney. A study of 29 patients and review of literature

Multilocular renal cyst is a distinct renal tumor whose gross external appearance and absence of normal renal tissue within the septa of loculi distinguish it clearly from other renal cystic lesions. Interlocular septa may contain either (1) fibrous tissue alone or (2) embryonic tissue separating adjacent loculi. Of 29 patients with multilocular renal cysts, 24 underwent a renal-sparing procedure, and only 5 had radical nephrectomy. None of the histologic specimens showed evidence of immature renal tissue or neoplasia. Patients were followed from three months to eight years (mean, 39 months), and no evidence of local recurrence or metastatic disease was found. Because it is difficult to distinguish multilocular renal cyst from cystic Wilms tumor and multicystic clear cell carcinoma on the basis of imaging studies alone, surgical intervention is the only effective method to differentiate multilocular renal cyst from a malignant lesion of the kidney.

Multilocular cyst (multilocular cystic nephroma) of the kidney: a report of 2 cases with an unusual mode of presentation

We report 2 cases of multilocular cyst (multilocular cystic nephroma) of the kidney in children who presented with sudden rapid growth of a renal mass.

Multilocular cyst of the kidney

Four examples of multilocular cyst of the kidney occurring in adult Chinese women are reported. This uncommon lesion has distinctive sonographic and clinicopathological features. The aetiology and pathogenesis are unknown. The differential diagnosis, pre-operative evaluation, and treatment are discussed.

Solitary cyst and clear cell adenocarcinoma of the kidney: report of 2 cases and review of the literature

We report 2 cases of a solitary simple cyst of the kidney harboring clear cell adenocarcinoma in the wall of the cyst. Cysts of the kidney may be divided into solitary cysts, that is large, unilocular cysts with a thin wall, and multilocular cysts, that is sharply demarcated multilocular epithelial-lined cysts with compression of the adjacent renal parenchyma. There are 4 types of tumor and cyst that occur in the same kidney, and our cases belonged to type 3. Suspicion of malignancy was raised by preoperative cytological examination of the fluid of the cysts. Perioperatively, however, no gross evidence of malignancy was found in either case. Frozen section biopsy in case 1 failed to confirm the diagnosis. The cysts were removed by partial nephrectomy. Patient 1 died within 2 years of widespread metastases. Patient 2 had undergone nephrectomy and was well. Based on the literature and our findings we strongly recommend the surgical approach of partial nephrectomy followed by total nephrectomy when the diagnosis has been confirmed.

Bilateral multilocular renal cysts

Multilocular renal cystic disease is a rare, benign condition thought to occur unilaterally. We report a case of asynchronous, bilateral multilocular renal cystic disease, which suggests that unilaterality is not essential for diagnosis of this lesion.