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Frumer M, Konen O, Shapira Rootman M, Soudack M, Ben-Shlush A, Ben-Meir D. The Modified Bosniak Classification for Intermediate-Risk Renal Cysts in Children. Urology 2020; 149:206-210. [PMID: 33129869 DOI: 10.1016/j.urology.2020.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine correlations of the modified Bosniak categories assigned by radiologists to histological results and inter-rater reliability, focusing on intermediate-risk lesions. MATERIALS AND METHODS The data of pediatric patients who underwent surgery for intermediate-risk complex renal cyst at a tertiary medical center in 2006-2019 were collected retrospectively. Four pediatric radiologists from 2 different medical centers reviewed the available imaging scans, and assigned each to one of the four modified Bosniak classification categories. Binary cohorts of the Bosniak categories (I-II vs III-IV) were compared to the histological results. Diagnostic accuracy (benign- vs intermediate-risk lesion) was calculated for each radiologist and for each imaging modality. Krippendorff's α test was used to measure inter-rater reliability. RESULTS The cohort included seven children, each with 1 complex cyst that was rated as intermediate-risk on pathological study. The median age was 1.5 years (IQR 1, 11.9). A correct classification was made in 41/56 imaging readings (sensitivity 73.2%). Applying Krippendorff's test to the binary Bosniak cohorts yielded poor inter-rater agreement (α = 0.08). CONCLUSION Implementation of the modified Bosniak classification in children caused a disconcerting underestimation of intermediate risk. There was a low inter-rater consistency for the categories intended to guide decisions regarding surgery or conservative management. The findings suggest that clinicians should be cautious using the modified Bosniak system for children.
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Affiliation(s)
- Michael Frumer
- Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | - Osnat Konen
- Department of Diagnostic Imaging, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mika Shapira Rootman
- Department of Diagnostic Imaging, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michalle Soudack
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Imaging, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Aviva Ben-Shlush
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Imaging, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - David Ben-Meir
- Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Narayanasamy S, Krishna S, Prasad Shanbhogue AK, Flood TA, Sadoughi N, Sathiadoss P, Schieda N. Contemporary update on imaging of cystic renal masses with histopathological correlation and emphasis on patient management. Clin Radiol 2018; 74:83-94. [PMID: 30314810 DOI: 10.1016/j.crad.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/06/2018] [Indexed: 01/21/2023]
Abstract
This article presents an updated review of cystic renal mass imaging. Most cystic renal masses encountered incidentally are benign and can be diagnosed confidently on imaging and require no follow-up. Hyperattenuating masses discovered at unenhanced or single-phase enhanced computed tomography (CT) measuring between 20-70 HU are indeterminate and can be further investigated first by using ultrasound and, then with multi-phase CT or magnetic resonance imaging (MRI); as the majority represent haemorrhagic/proteinaceous cysts (HPCs). Dual-energy CT may improve differentiation between HPCs and masses by suppressing unwanted pseudo-enhancement observed with conventional CT. HPCs can be diagnosed confidently when measuring >70 HU at unenhanced CT or showing markedly increased signal on T1-weighted imaging. Although the Bosniak criteria remains the reference standard for diagnosis and classification of cystic renal masses, histopathological classification and current management has evolved: multilocular cystic renal cell carcinoma (RCC) has been reclassified as a cystic renal neoplasm of low malignant potential, few Bosniak 2F cystic masses progress radiologically during follow-up; RCC with predominantly cystic components are less aggressive than solid RCC; and Bosniak III cystic masses behave non-aggressively. These advances have led to an increase in non-radical management or surveillance of cystic renal masses including Bosniak 3 lesions. Tubulocystic RCC is a newly described entity with distinct imaging characteristics, resembling a pancreatic serous microcystadenoma. Other benign cystic masses including: mixed epithelial stromal tumours (MEST) are now considered in the spectrum of cystic nephroma and angiomyolipoma (AML) with epithelial cysts (AMLEC) resemble a fat-poor AML with cystic components.
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Affiliation(s)
- S Narayanasamy
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - S Krishna
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - A K Prasad Shanbhogue
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, USA
| | - T A Flood
- Department of Anatomic Pathology, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - N Sadoughi
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - P Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - N Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
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Chung EM, Graeber AR, Conran RM. Renal Tumors of Childhood: Radiologic-Pathologic Correlation Part 1. The 1st Decade: From the Radiologic Pathology Archives. Radiographics 2017; 36:499-522. [PMID: 26963460 DOI: 10.1148/rg.2016150230] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Wilms tumor is the second most common pediatric solid tumor and by far the most common renal tumor of infants and young children. As most tumors are large at presentation and are treated with nephrectomy, the role of imaging is primarily in preoperative planning and evaluation for metastatic disease. However, with treatment protocols increasingly involving use of preoperative (neoadjuvant) chemotherapy (the standard in Europe) and consideration of nephron-sparing surgery, the role of imaging is evolving to include providing initial disease staging information and a presumptive diagnosis to guide therapy. Differential diagnostic considerations include lesions that are clinically benign and others that require more intensive therapy than is used to treat Wilms tumor. In part 1 of this article, the unique histologic spectrum of renal neoplasms of infants and young children is reviewed with emphasis on radiologic-pathologic correlation. Part 2 will focus on renal tumors of older children and adolescents.
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Affiliation(s)
- Ellen M Chung
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Adam R Graeber
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Richard M Conran
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
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A Case of Bilateral Cystic Partially Differentiated Nephroblastoma vs Cystic Wilms' Tumor: Highlighting a Diagnostic Dilemma. Urology 2016; 92:106-9. [DOI: 10.1016/j.urology.2016.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 11/22/2022]
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Odubanjo M, Ademuyiwa A, Daramola A, Orah N, Elebute O, Abdulkareem F, Akinde O. Cystic poorly differentiated nephroblastoma: A case report and review of literature. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Segmental multicystic dysplastic kidney in an adult: usefulness of enhanced CT in excretory phase. ABDOMINAL IMAGING 2012; 38:603-7. [PMID: 22782317 DOI: 10.1007/s00261-012-9938-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We present an adult case of segmental multicystic dysplastic kidney (SMCDK). The patient had a 10 × 6 cm oval-shaped mass consisting of a solid and multilocular cystic component at the right upper renal sinus. The solid component showed gradual and mild enhancement on dual-phase enhanced CT. Excretory-phase CT demonstrated the excretion of contrast medium into the septa and cysts. Dilation of the upper calices and renal pelvis and atretic renal pelvis in the mass were also clearly visualized in the excretory phase. The signal intensity of the solid component was slightly lower than that of the renal parenchyma on T2-weighted images and similar to that of the medulla on diffusion-weighted images. Right nephrectomy showed a multilocular cystic component within the renal sinus and some of the cysts contained blood. The renal pelvis of the upper moiety was blind, as suggested by CT. Microscopically, there were multiple non-communicating small cysts, as shown by CT, and the wall was lined with immature tubule-like cells. In addition, immature tubule-like cells were seen in the septa. Immature mesenchymal cells were seen around the cysts. The solid component mainly consisted of fibroconnective tissue with immature tubule-like cells. The pathological diagnosis was confirmed as SMCDK. Excretion of contrast media into the septum and cystic component might be a characteristic finding of SMCDK in addition to the finding of a multilocular cystic mass in the upper moiety with urinary tract abnormality.
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Case report: a left upper quadrant complex cystic mass. Int J Surg Case Rep 2012; 3:65-7. [PMID: 22288048 DOI: 10.1016/j.ijscr.2011.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 08/31/2011] [Accepted: 09/11/2011] [Indexed: 11/22/2022] Open
Abstract
A 61-year-old woman presented with left upper quadrant/flank pain and increasing abdominal girth. CT scan showed a large complex, multi-cystic lesion in the left abdomen. Laparotomy revealed a large retroperitoneal mass attached to the left kidney. Left nephrectomy was performed and pathology demonstrated a benign cystic nephroma. Surgical oncologists should be aware of this rare renal lesion as the clinical and radiographic presentation may mimic other intra-abdominal cystic lesions.
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Bhardwaj AK, Sharma PD, Mittal A, Sharma A. Bilateral cystic nephroma with pleuropulmonary blastoma. BMJ Case Rep 2011; 2011:bcr.05.2011.4171. [PMID: 22688934 DOI: 10.1136/bcr.05.2011.4171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cystic nephroma is a rare benign renal neoplasm that is purely cystic and is lined by an epithelium. Bilateral cystic nephromas are even rarer with only a handful cases reported in the literature. A case of a 2-year-old male child who presented with bilateral renal cystic masses later diagnosed as cystic nephromas is presented here. Ultrasound, CT scan and histopathological investigations aided in arriving at the correct diagnosis. The most concerning feature was the presence of a fluid filled cystic mass in the lungs, most probably a pleuropulmonary blastoma which is a rare malignant neoplasm known to be associated with bilateral cystic nephromas. The most common presenting symptoms of cystic nephroma are painless abdominal mass, abdominal or flank pain and haematuria. These tumours usually follow a benign course and nephrectomy alone is curative. A close surveillance of such patients is recommended because of elevated risk of other tumours.
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Affiliation(s)
- Anand Kumar Bhardwaj
- Paediatrics Department, MM Institute of Medical Sciences and Research, Ambala, Haryana, India.
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Agarwal AK, Das S, Agarwal A, Ghosh D, Chaterjee N, Pal MS. Pleuropulmonary blastema with cystic nephroma - A rare presentation and surgical dilemma. Indian J Pediatr 2008; 75:1266-8. [PMID: 19057859 DOI: 10.1007/s12098-008-0212-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 08/29/2007] [Indexed: 10/21/2022]
Abstract
Pleuropulmonary balstema with cystic nephroma is a rare dual pathology of pediatric age group. The etiopathogenesis of this entity is not known, still researches indicate towards a common genetic cause. We report a case of this dual pathology in a one and half year old male. Till now only 5 cases have been reported.
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Silver IMF, Boag AH, Soboleski DA. Multilocular Cystic Renal Tumor: Cystic Nephroma. Radiographics 2008; 28:1221-5; discussion 1225-6. [DOI: 10.1148/rg.284075184] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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La Parra Casado C, Muro Velilla D, Molina Fàbrega R, Sangüesa Nebot C. Hallazgos radiológicos de los tumores renales no-Wilms en la edad pediátrica. RADIOLOGIA 2008; 50:215-24. [DOI: 10.1016/s0033-8338(08)71967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hsiao HL, Wu WJ, Chang MY, Ke HL, Huang CH. Unusual Case of Multilocular Cystic Nephroma Treated with Nephron Sparing Technique: A Case Report. Kaohsiung J Med Sci 2006; 22:515-8. [PMID: 17098684 DOI: 10.1016/s1607-551x(09)70346-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Multilocular cystic nephroma is an unusual entity of uncertain etiology that can affect children and adults equally. This lesion is believed to be part of a spectrum of renal cystic disorders with multilocular cyst and cystic Wilms' tumor representing the two extremes and usually presents with a benign character. We report a 22-year-old female who presented with a painful right renal mass and gross hematuria. After a series of examinations including abdominal ultrasound, computed tomography, and angiography, she underwent partial nephrectomy under the impression of benign lesion. The pathologic examination showed that it was a multilocular cystic nephroma. At the 11-month follow-up, the patient was completely asymptomatic and free of recurrence and metastasis.
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Affiliation(s)
- Hsi-Lin Hsiao
- Department of Urology, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
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