Complex Renal Cysts Research Articles

Clinical Correlation Between Computerized Tomography Findings and Pathologic Diagnosis in Patients Surgically Treated for Complex Renal Cysts in a Colombian Tertiary Center.

IntroductionRecent data have reexamined the historical rates of malignancy observed in Bosniak IIF and III cystic lesions, and this has led to an endorsement of the use of active surveillance as the standard of care for Bosniak III renal cysts by affirming that overtreatment rates for this subgroup are close to 50%. In light of this, the present study describes the correlation between imaging studies and pathologic diagnosis in patients surgically treated for complex renal cysts in Colombia.Materials and methodsThis is a retrospective, descriptive, and observational study. We analyzed the medical histories of patients who had been surgically treated for complex renal cysts between 2010 and 2018 in the urology department of a tertiary center in Bogota, Colombia. The exclusion criteria were incomplete clinical histories and absent diagnostic images or their official interpretation.ResultsOut of the 235 urological procedures performed, nine were excluded. And 6.19% (n = 14) were cases of surgically treated complex renal cysts; 38.46% were compatible with Bosniak IIF, 46.15% were Bosniak III, and 15.38% were Bosniak IV. The percentage of renal cancer as revealed by the histopathological study was 60, 66.7 and 100 for renal cysts Bosniak IIF, III, and IV, respectively; 77.7% of these confirmed oncological cases had received a diagnosis of clear cell renal carcinoma.ConclusionsIn our study, the percentage of malignancy in patients with renal cysts Bosniak IIF and III was found to be greater compared to the findings in the recent medical literature. We believe that the management offered to the population with complex renal cysts in Colombia should be tailored to the individual risk characteristics of each patient.

A Rare Finding of Clear Cell Papillary Renal Cell Carcinoma in a Complex Renal Cyst

Multilocular cystic renal cell carcinomas (RCC’s), Unilocular cystic RCC’s and RCC’s with extensive cystic necrosis and unilocular cysts with mural tumor nodules forms a wide category of RCC’s. Cystic RCC’s represent upto 3-14% of all RCC’s.[1] Here we present a case of 68 year old female who is a known case of DM, hypothyroidism, bronchial asthma presenting with complains of pain abdomen since 1 year. She has been a case of renal TB and on ATT 30 years ago. Further the patient was evaluatedand foundto have a small partly exophytic cortical cyst measuring 13x12mm noted in the inter polar region posteriorly along with multiple well defined hyper dense non enhancing cortical and exohytic cysts notes in upper / lower and inter polar regions, largest measuring 1.8x1.7cms in upper pole suggestive of hemorrhagic cysts. A diagnosis of left renal complex cyst was made. Alaporoscopic left partial cystectectomy was done and sent for histopathological examination. Microscopy revealed Cystic clear cell fgv Renal cell carcinoma, Furhman Grade 1(Low grade) within a 0.1cm thickening which was further confirmed with IHC expressing strongly for CK7,PAX8 and CAIXand confirmed the diagnosis as Clear cell Papillary Renal cell carcinoma. Patient is being followed up and no recurrence / metastasis has been reported. This provides us an opportunity to consider an unusual finding of Clear Cell Papillary RCC in a complex renal cyst and to look into the cystic lesion with more importance helping us in avoiding missing a carcinoma as found in the present case.

AN EXPERIENCE OF PARTIAL NEPHRECTOMY IN A PATIENT WITH VON WILLEBRAND DISEASE

A 28-year-old male visited a nearby hospital with chief complaint of bilateral back pain and fever. He was diagnosed with a right complex renal cyst (Bosniak classification, IIF) with a kidney stone and was referred to our hospital. We first suspected an incarcerated kidney stone and performed flexible transurethral lithotomy; however, his symptoms did not improve. Blood examination revealed prolonged APTT; subsequently, he was diagnosed with von Willebrand disease (VWD). Because he experienced pain due to the hemorrhagic renal cyst, we performed partial nephrectomy. Preoperatively, we supplemented the von Willebrand factor (VWF) based on the VWF activity in the patient. Although intraoperative bleeding was well controlled, he developed bleeding from pseudoaneurysms on the postoperative day (POD) 6. We immediately performed transarterial embolization along with VWF replenishment. VWF supplementation was discontinued on POD 14, and the patient was discharged on POD 23. Since then, he has not experienced a bleeding recurrence or pain. In patients with VWD, the perioperative administration of desmopressin or VWF is recommended. Although several reports showed that surgeries involving these treatments are safe, only three cases with VWD, including the present case where the patient underwent partial nephrectomy, have been reported. In the present case, postoperative bleeding occurred despite exhibiting adequate perioperative VWF activity. Thus, bleeding complications in patients with VWD undergoing partial nephrectomy must be considered and should be carefully followed up.

Crizotinib-Associated Renal Cysts: A Case Series

AbstractCrizotinib is an anaplastic lymphoma kinase (ALK) inhibitor, used as a targeted chemotherapeutic agent in ALK-positive cases of nonsmall cell lung carcinoma. Although uncommon, it may be associated with the formation of new renal cysts, which may be simple or complex, or the enlargement of preexisting simple renal cysts or their transformation into complex cysts. These cysts usually regress partially or completely but may rarely enlarge over time or get complicated by infection or abscess formation. Such cases may even require dose reduction or withholding crizotinib. Although documented in clinical literature, this entity is not well known among radiologists. Knowledge of this entity helps in preventing erroneous diagnosis of the new kidney “lesion” as metastasis or disease progression and avoids an unnecessary biopsy. We describe a series of four cases which developed complex renal cysts during treatment with crizotinib to demonstrate this point.

The Prevalence, Clinicodemographics, and Outcomes of Incidental and Symptomatic Renal Cysts in a Pediatric Cohort Undergoing Ultrasonography.

The growing availability of modern-day imaging has resulted in an increase in the number of renal cysts detected in the pediatric population. Few publications have reported outcomes of these childhood cysts. In this study we assessed the prevalence and evolution of renal cysts in children, and described clinical characteristics, mode of presentation and ultimate outcomes. Our institutional ultrasound database was searched for all abdominal ultrasound reports from 2006 to 2017. These reports were then cross-referenced with a manual retrospective chart review. Clinical characteristics including mode of presentation, cyst characteristics, and outcomes were analyzed using descriptive and nonparametric statistical methods. Of 70,500 abdominal ultrasound scans during the study period 1,531 (2.2%) met the study inclusion criteria. Overall 26% of cysts were complex and 10.1% of cases were associated with hydronephrosis. Echogenic kidneys were more likely to be associated with simple cysts (p=0.0001). There was no difference between cyst diameter and symptomatology (p=0.82). The conversion of simple to complex renal cysts was less than 1% and 1.8% of complex cysts developed renal cell carcinoma. In a large cohort of children who underwent abdominal imaging we found a 10-year renal cyst prevalence of 2.2%. Given that nearly all cysts follow a benign course and that simple cysts will invariably grow within 2 years, we believe that these cases could be safely discharged after that point. We continue to recommend surveillance for patients with cysts larger than 15 mm, complex cysts, family history of adult polycystic kidney disease or those with concomitant genitourinary anomalies requiring ongoing followup.

A Complex Renal Cyst in a Patient on Crizotinib: Case Report

A Complex Renal Cyst in a Patient on Crizotinib: Case Report

The Histopathologic Correlation of Bosniak 3 Cyst Subclassification

ObjectiveTo evaluate the histopathologic correlation of recently described subclassification of Bosniak category 3 cysts (3s and 3n). Materials and MethodsA total of 106 patients who underwent partial/radical nephrectomy due to a complex renal cyst (≥Bosniak 3) were retrospectively reviewed. All the scans of the patients were reevaluated by 2 experienced uroradiologists. Bosniak 3 cysts were reclassified as 3n (nodularity on the cyst wall/septae) and 3s (septated cysts without nodularity) as described in a recently published paper. Group 1 consisted of patients with Bosniak 3s, Group 2 consisted of patients with Bosniak 3n, and Group 3 consisted of patients with Bosniak 4 cysts. Three groups were compared according to patients' characteristics, radiological findings, histopathologic results, and survival outcomes. ResultsThere were 52 patients in Bosniak 3 group and 54 patients in Bosniak 4 group. Mean follow-up was 35.3 months. Among Bosniak 3 cysts, 37 lesions were classified in 3s and 15 were classified in 3n. Malignancy was higher in 3n group than 3s (86.7% vs 54.1%, P= .026). Lesion size was significantly lower for malignant cysts compared to benign ones in the patients with Bosniak 3 lesions (44.2 ± 27.5 vs 80 ± 55.9 P= .005). In the subgroups, malignant lesions were significantly smaller than benign lesions in 3s group similar to general Bosniak 3 group. Most of the Bosniak 3 lesions were organ confined and low grade. ConclusionThe subclassification of Bosniak 3 cysts as 3s and 3n can help to differentiate highly suspicious malignant lesions from the relatively less suspicious ones.

318 - Complex renal cysts: Examining the applicability of modified Bosniak classification for children

318 - Complex renal cysts: Examining the applicability of modified Bosniak classification for children

797 - Comparison of computed tomography and contrast enhanced ultrasound for the management of complex renal cysts: A single-center experience

797 - Comparison of computed tomography and contrast enhanced ultrasound for the management of complex renal cysts: A single-center experience

Renal cyst evolution in childhood: a contemporary observational study

Children with renal cysts often undergo ultrasound (US) monitoring to identify malignant transformation or polycystic kidney disease (PKD). However, the utility of ongoing surveillance is uncertain. The objective of this study was to assess the natural history of simple or minimally complex cysts and the proportion of progression to autosomal dominant polycystic kidney disease (ADPKD), autosomal recessive polycystic kidney disease (ARPKD), or malignancy. The institutional review board approved retrospective chart review at one institution between 2004 and 2014. Eligible patients had ≤3 simple or minimally complex cyst(s) discovered on US without an initial diagnosis of multicystic dysplastic kidney, genitourinary malignancy, ADPKD, or ARPKD. Patient demographics and cyst details were recorded at identification and follow-up visits. Logistic regression was used to examine univariate association between diagnosis of ADPKD/ARPKD and each recorded variable. Eighty-seven eligible patients were identified. Twenty-two patients were identified antenatally or in the first year of life; the remaining 65 were identified at >1 year of age, median 7.6 years (interquartile range [IQR]: 4.2, 10.6). Most (60/87, 69%) had a solitary cyst at initial US. The median length of follow-up was 4.1 years (IQR: 1.9, 6.8) with median 3 follow-up US (IQR: 2, 5). Eleven patients (12.6%) were diagnosed with ADPKD. One patient (1.2%) was diagnosed with ARPKD. A median 2 follow-up US (IQR: 1, 4) procedures were performed over a median of 2.2 years (IQR: 1.0, 3.9) to obtain diagnoses of ADPKD or ARPKD. No patients developed malignancy. This study's results reveal that children identified to have a small number of simple or minimally complex renal cysts on initial US are unlikely to require additional treatment for these cystsas transformation to PKD or malignant condition is rare. Supporting this are results from literature that although simple cysts in childhood may evolve over time, most do not require any surgical or invasive treatment in the long term. Limitations include retrospective design and single institution. Autosomal dominant polycystic kidney disease/autosomal recessive polycystic kidney disease diagnosis occurs early in follow-up evaluation in children with simple or minimally complex cysts. Malignant transformation did not occur in any patients in this study. This study examines the natural history of renal cysts in childhood. Following up simple renal cysts routinely beyond 2-3 years after initial detection may not be optimal due to the use of limited medical resources.

Progression rate in Bosniak category IIF complex renal cysts.

ObjectiveTo evaluate progression rate of Bosniak category IIF complex renal cysts and the malignancy rate among surgically resected cysts.Materials and MethodsWe performed a database search for complex renal cysts classified as Bosniak category IIF on computed tomography or magnetic resonance imaging between January 2008 and April 2016. Follow-up examinations (computed tomography or magnetic resonance imaging) were used in order to evaluate progression (Bosniak category reclassification) and stability, the latter being defined as remaining stable for a minimum of six months. Pathology reports were used as the reference to assess the malignancy rate of surgically resected cysts.ResultsA total of 152 cysts in 143 patients were included in the final analysis. Seven cysts (4.6%) were reclassified on follow-up studies, and mean time to progression was 20 months (range, 1 month to 4 years). Three cysts were surgically resected. All three were diagnosed as low-grade malignant renal cell carcinomas (RCCs): one clear cell RCC and two papillary RCCs. The remaining 145 cysts remained unchanged after a mean follow-up period of 28 months (range, 6 to 118 months).ConclusionThe progression rate in Bosniak category IIF cysts was low. Even lesions that were upgraded on follow-up remained stable, indicating an indolent behavior. Our data support the idea of conservative management of Bosniak IIF renal cyst.

36] Dynamic contrast-enhanced ultrasonography for better percutaneous nephrolithotomy puncture

ObjectiveTo assess the efficiency of dynamic contrast-enhanced ultrasonography (DCE-US) for percutaneous nephrolithotomy (PCNL) puncture, as in recent years US contrast agents (microbubbles) have been used safely for cardiovascular and liver diseases diagnosis, and also to identify complex renal cysts, thus could be used to better delineate the pyelocalyceal system during PCNL puncture and reduce the radiation exposure for medical staff and patients.

P176 - Comparison of computed tomography (CT) and contrast enhanced ultrasound (CEUS) for the management of complex renal cysts: A single-center experience

P176 - Comparison of computed tomography (CT) and contrast enhanced ultrasound (CEUS) for the management of complex renal cysts: A single-center experience

Bosniak Category III Renal Cysts Caused by Crizotinib in an Anaplastic Lymphoma Kinase Gene-Rearranged Non–Small Cell Lung Cancer Patient

Bosniak category III renal cystic masses are often treated with surgical resection because of high risk of malignancy. Crizotinib is an anaplastic lymphoma kinase (ALK) inhibitor used to treat ALK gene-rearranged non–small cell lung cancer and reported to be associated with complex renal cyst formation. We herein report a case of Bosniak category III renal cysts occurred in a crizotinib-treated ALK gene-rearranged non–small cell lung cancer patients. The cysts regressed spontaneously after cessation of crizotinib and we could thus avoid unnecessary surgical resection.

Case series of collapsed simple renal cysts potentially simulating cystic malignancy at CT

The radiological differential diagnosis for complex renal cysts seen at CT generally includes cystic malignancy or renal abscess. We have encountered five cases of complex-appearing renal cysts at CT where serial imaging and clinical outcome favored a diagnosis of a collapsed benign simple renal cyst. We present these cases to broaden the differential diagnosis for complex renal cysts seen at CT, highlighting the importance of careful correlation with prior imaging to assist in correct recognition of collapsed simple cysts and potentially allowing for conservative management or surveillance.

Natural History of Complex Renal Cysts

Cystic renal masses — common incidental findings on abdominal imaging — traditionally are labeled according to the Bosniak classification system.

Cystic Renal Cell Carcinoma: A Report on Outcomes of Surgery and Active Surveillance in Patients Retrospectively Identified on Pretreatment Imaging

We evaluated the outcomes of surgical intervention and active surveillance in patients diagnosed with cystic renal cell carcinoma at our hypothesized radiological cutoff of greater than 50% cystic. We identified all 430 patients with a pathologically confirmed cystic renal mass that fit our criteria from 2000 to 2015. The 292 patients with a lack of computerized tomography, tumors less than 50% cystic on imaging, multifocal tumors and prior renal cell carcinoma were excluded from study. Patients were stratified into benign or malignant subgroups, and radiological, clinicopathological and oncologic features were determined. Univariate and multivariate associations between clinicoradiological parameters in each group were analyzed. We similarly reviewed the records of a separate cohort of patients treated with active surveillance for cystic renal cell carcinoma. Of the 138 identified cases of cystic renal cell carcinoma 102 (73.9%) were renal cell carcinoma and 36 (26.1%) were benign masses. Of the tumors 77.5% were Fuhrman grade 1-2, 83.4% were stage pT2 or less and 65.9% showed clear cell histology. On univariate analysis male gender, a solid component and increasing Bosniak classification were significant for malignancy. In a separate cohort we identified 38 patients on active surveillance. The growth rate was 1.0 mm per year overall and 2.3 mm per year for the solid component. At a median followup of more than 4 years in all cohorts there was no evidence of recurrence or metastasis of cystic renal cell carcinoma. Patients with unifocal cystic renal cell carcinoma evaluated using a standardized radiological threshold of greater than 50% cystic had an excellent prognosis on active surveillance and after surgical resection.

Non-conservative management of simple renal cysts in adults: a comprehensive review of literature.

Renal cysts are common findings in nearly 10% of general population. According to Bosniak classification, they are classified into simple and complex renal cysts based on their CT characteristics. The majority of simple renal cysts are asymptomatic and require no intervention. Once they become symptomatic or complicated, a non-conservative management should be considered. This paper is a narrative review of existing manuscripts regarding the non-conservative management of renal cysts. To perform it a search through PubMed was carried out in January 2017. The search was conducted using the following key words: "simple renal cysts," "non-conservative management," "treatment outcomes comparison" etc. EVIDENCE SYNTHESIS: We found 1880 publications that were reviewed by 2 of our authors, and only 46 manuscripts were considered for this review. The most common treatment were investigated and compared to understand the best treatment modality in accordance with patients' and cysts' characteristics. Different treatment modalities are available for the management of simple renal cysts. Surgical exploration is a historical procedure that is no longer used. Simple aspiration without sclerotherapy has high recurrence rate (20-80%), so sclerosants agents are recommended. Ethanol is the most commonly used sclerosing agent with high efficacy up to 97%. Laparoscopy is the gold standard for management in large cysts especially in younger patients. Other techniques are described for parapelvic renal cysts like percutaneous endoscopic ablation and ureteroscopic marsupialization. Different factors affect the treatment decision including natural history of the cyst, presence of symptoms and/or complications and patients' choice. This literature overview shows that ethanol percutaneous sclerotherapy and laparoscopy are the most commonly reported treatment modality for simple renal cysts.

Simple and complex renal cysts in adults: Classification system for renal cystic masses.

Ultrasound and slice imaging are currently the key modalities for diagnosing simple renal cysts. Benign simple renal cysts are defined by a set of strict criteria. Any cystic lesions that do not meet these criteria should be classified as "atypical" or "complex" and considered as suspicious. For over three decades, the Bosniak classification has been the central tool for diagnosing renal cystic masses larger than 1cm. The Bosniak classification is based upon the results of a well-established pre- and post-contrast computed tomography (CT) protocol. Lesions that are difficult to classify or that remain indeterminate after CT can benefit from a multimodal diagnostic approach combining CT, non-contrast-enhanced and contrast-enhanced ultrasound, and magnetic resonance imaging.

Giant incisional hernia containing a large renal cyst

Introduction Hernias are common surgical diseases. Incidence of incisional hernia depends upon the size and location of the former incision and ranges from 3 to 20 percent. In clinical practice the variability of surgical techniques for hernia repair is great and a wide range of publications are available. Surgery for renal cysts depends on whether they are classified simple or complex. Simple cysts are more common and the majority requires no treatment. Complex renal cysts are associated with an increased risk of malignancy. This is the first report on a giant incisional hernia containing bowl combined with a voluminous renal cyst. Case description An 80-year-old female diagnosed with a giant incisional hernia combined with a large left renal cyst was referred to our surgical department from a peripheral hospital for hernia repair. Physical examination showed a ventral incisional hernia (50x50cm) extending to the upper thigh with multiple skin lesions and clinical signs of obstipation. CT scan revealed two hernial orifices measuring 13cm and 4.5cm in diameter. The giant hernial sac contained not only incarcerated small and large bowl but also a large left renal cyst containing 3 litres of fluid. Results and Conclusions We performed a second median laparotomy with complete release of all abdominal adhesions. The renal cyst was resected and its base marsupialized. Hernia repair was achieved by both sided compartment separation as described by Ramirez combined with an intraperitoneal onlay mesh sized 40cmx60cm. Intraoperative measurement of creatinine in the cyst fluid revealed no connection to the urinary tract making further renal surgery unnecessary. By resecting the renal cyst, intraabdominal volume was markedly reduced allowing tension free abdominal wall reconstruction. Histological examination of the cyst, the hernial sacs and the resected skin revealed no surprising findings. Postoperative recovery was uneventful and drains were removed before discharge. Bowel movement started on the third postoperative day. Wound dehiscence was treated by negative pressure wound therapy and no recurrence has yet been detected two months postoperatively. Take home message Surgical repair of giant incisional hernias is challenging and is associated with significant morbidity and mortality. Individual planning of abdominal wall reconstruction is key for successful treatment and is even the more important in complex hernias with loss of domain or accompanying intraabdominal pathologies.