Multilocular Cystic Nephroma: Is Radical Nephrectomy The Best Treatment In All Cases? Our Experience After 45 Years Working on a Tertiary Care Center

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Introduction: Multilocular cystic nephroma (MCN) is a type of benign renal tumor that is sometimes misdiagnosed with cystic Wilms Tumor. Given that each one has a different treatment, it is essential to make a proper diagnosis. Objective: Our aim was to find the differential characteristics of MCN and to be able to identify these renal masses with low probability of malignancy, which are subsidiaries of a more conservative treatment. Material and Methods: We conducted a retrospective descriptive study were we analyzed the patients with MCN treated in our center between 1971 and 2016. Results: We found 13 patients with a histological diagnosis of MCN, mostly males, with an average age of 46.8 months at the time of surgery. Clinically, 2 cases (15.4%) were asymptomatic, 6 had an abdominal mass (46.1%), 3 had abdominal pain (23.1%) and 2 had hematuria (15.4%). The maximum diameter of the mass was 7.3 cm (mean). 9 nephrectomies (69.2%) and 4 tumorectomies (30.8%) were performed. In two of these (15.4%), neoadjuvant chemotherapy was administered due to presurgical suspicion of Wilms' tumor, which was discontinued after the pathological analysis. In another 4 patients with suspicion of MCN, all of them asymptomatic and with a tumor size <3cm, non-surgical treatment was decided. At the present time all patients (operated or not) stay alive. No. cases of distant metastasis, local recurrence or mass progression (in the non-operated patients) have been recorded. Conclusion: Given its good prognosis, MCN can be treated with a non-radical surgery or even non-surgical conservative treatment in selected cases. In our experience, the clinical and radiological characteristics are the pillars to identify those patients with low risk of malignancy in which this attitude could be carried out.