Management of 43 cystic renal cell carcinomas in 10 years

Abstract

Objective To present a cohort of cystic renal cell carcinoma (CRCC) with long-term follow up,and share our experience in the management of this disease.Methods From September 2002 to September 2012,43 cases of CRCC were treated.Among these patients,16 cases was diagnosed as simple renal cyst (SRC) by CT scan or MRI prior to operation,and malignant tumors were detected by pathological analysis following cyst decortications.Fifteen of them received supplementary nephrectomy within 2 months,whereas 1 patient underwent active surveillance.The other 27 patients underwent surgical treatment because CT or MRI confirmed complicated renal cysts,of which 20 cases were followed up once as SRC and monitored by uhrasound about every 6 months,until complicated variation of SRC was confirmed.Median follow up was 48 months (12 to 132 months).Results Pathological studies confirmed stage Ⅰ to Ⅱ clear cell RCC in all 43 cases,with Fuhrman grade Ⅰ to Ⅱ.Especially,complicated variation of SRC universally turned out to be malignant.In decortication-detected malignancies,supplementary nephrectomy detected residual tumor in 8 out of 15 cases.There were no local recurrence or metastases during follow up,including the patient who chose active surveillance for 96 months.Conclusions RCC may be incidentally detected in SRC,and more attention should be paid to complicated variation of SRC during surveillance due to the extremely high probability of malignancy.Prognosis is good for CRCC with timely surgical treatment. Key words: Cystic renal cell carcinoma; Diagnosis; Treatment; Prognosis