Unusual Case of Multilocular Cystic Nephroma Treated with Nephron Sparing Technique: A Case Report

Adult multilocular cystic nephroma: Report of six cases with clinical, radio-pathologic correlation and review of literature

Background:

Cystic renal neoplasms of the kidney can be benign or malignant. Multicystic nephroma (MCN) represents a rare benign cystic lesion of the kidney, which usually presents as a unilateral multicystic renal mass without solid elements. According to the World Health Organization (WHO) classification of the renal neoplasms, it is grouped along with mixed epithelial–stromal tumor of the kidney.

Materials and Methods:

We report a retrospective review of six cases of MCN of kidney. Patient demographics, imaging findings, operative details and final histology were recorded.

Results:

All patients had suspicious/malignant features on radiological examination, leading to a radical nephrectomy. However, microscopically these lesions were lined by cuboidal epithelium, and in a few places hobnail epithelium. No cells with clear cytoplasm, blastemal or immature elements were seen. In one case, foci of inflammatory cells and histiocytes were present.

Conclusions:

MCN is a benign cystic lesion and clinical presentations are nonspecific with symptoms such as abdominal pain, hematuria and urinary tract infection. These nonspecific clinical presentations and confusing radiological features create difficult preoperative differentiation from malignant cystic renal neoplasms.

Multilocular Cystic Renal Cell Carcinoma: Our Experience

Multilocular cystic renal cell carcinoma is now recognized as an independent pattern by WHO; it is a rare malignancy with a predominantly cystic growth, characterized by very low oncologic evolution and then susceptible to conservative treatment. In the kidney cystic masses of different origin may arise, i.e. due to malformation, acquired disease or tumor. Renal neoplastic lesions may have a cystic or pseudocystic component. There are also four types of neoplasm with a predominantly cystic growth, including the multilocular cystic carcinoma, which are macroscopically very similar and impossible to differentiate through diagnostic pre-operative images. The Authors present four cases of multilocular cystic renal cell carcinoma diagnosed in the 2000–2007 period, with special reference to diagnostic difficulties and to pre- and intra-operative features of the neoplasm. In conclusion, the extemporaneous histological preoperative diagnosis of multilocular cystic renal cell carcinoma is not possible because it requires extensive sampling; furthermore, the final histological diagnosis sometimes needs particular immunohistochemical procedures to be confirmed.

Cystic nephroma and localized renal cystic disease in children: diagnostic clues and management

BACKGROUND AND PURPOSE

Cystic nephroma (CN) and localized renal cystic disease (LRCD) are rare benign renal entities that can occur in children. A retrospective evaluation of the experience with these conditions was performed to emphasize the importance of differential diagnosis, recognition, and selection of the proper mode of treatment.

MATERIALS AND METHODS

The medical records of patients treated for CN (n = 4) and LRCD (n = 1) between 1980 and 2007 were retrospectively evaluated. The age, sex, family history of renal cystic disease, presenting symptoms, physical examination findings, diagnostic radiologic imaging used, operative findings, details of the surgical procedure, histopathologic features, and outcomes were evaluated.

RESULTS

There were 4 cases of CN and 1 case of LRCD without a positive family history. The age and sex of patients with CN were two 1-year-old girls and two 1.5-year-old boys. The patient with LRCD was a 4.5-year-old girl. The presenting symptoms were palpable mass in patients with CN and urinary tract infection in the patient with LRCD without impairment of renal function. Intravenous pyelography (n = 2), abdominal ultrasonography (n = 4), and computed tomography (n = 4) were used. All patients underwent an operation. Nephrectomy was performed in all 4 CN cases, and total excision of the cyst was performed in the LRCD case.

CONCLUSION

Pediatric surgeons should be familiar with the clinical, radiologic, surgical, and histopathologic characteristics of CN and LRCD. The presumptive diagnosis of CN prompts surgical intervention. Enucleation or partial nephrectomy is the treatment of choice in suitable cases. Nephrectomy should be reserved for CN, which totally replaces the parenchyma. Conservative treatment with follow-up imaging may be considered in selected cases of LRCD that have characteristic computed tomographic criteria. Operative intervention is indicated in symptomatic cases and should be limited to simple excision of the cysts.