Cystic Renal Tumors Research Articles

ТУБУЛОКИСТОЗНАЯ ПОЧЕЧНО-КЛЕТОЧНАЯ КАРЦИНОМА: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ И ОБЗОР ЛИТЕРАТУРЫ

Tubulocystic renal cell carcinoma is a rare malignant epithelial tumor with unique morphological features. It usually demonstrates indolent behavior with low recurrence rate and low metastatic potential. Here we present literature review and a case report of 65 y.o. woman with tubulocystic renal cell carcinoma. Pitfalls of differential diagnostic with other cystic renal neoplasms are shown.

PD22-07 A MULTICENTER STUDY PRESENTING AN EXPLAINABLE AI APPROACH TO AUTOMATIC SEGMENTATION OF RENAL TUMORS ON COMPUTED TOMOGRAPHY

You have accessJournal of UrologyCME1 Apr 2023PD22-07 A MULTICENTER STUDY PRESENTING AN EXPLAINABLE AI APPROACH TO AUTOMATIC SEGMENTATION OF RENAL TUMORS ON COMPUTED TOMOGRAPHY Annemarie Uhlig, Sophie Bachanek, Paul Romario Würzberg, Manuel Nietert, Lutz Trojan, Joachim Lotz, and Johannes Uhlig Annemarie UhligAnnemarie Uhlig More articles by this author , Sophie BachanekSophie Bachanek More articles by this author , Paul Romario WürzbergPaul Romario Würzberg More articles by this author , Manuel NietertManuel Nietert More articles by this author , Lutz TrojanLutz Trojan More articles by this author , Joachim LotzJoachim Lotz More articles by this author , and Johannes UhligJohannes Uhlig More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Automatic segmentation of renal tumors is a cornerstone for Artificial Intelligence (AI) based tumor diagnostics. This study presents an automatic segmentation algorithm and visualization method using CT-studies from renal tumor patients recruited in a multicenter setting. METHODS: Renal tumor patients diagnosed between 2018 and 2021 were retrospectively assessed for this study. Inclusion criteria were CT-imaging of renal tumors in corticomedullary (CM) or nephrogenic (NG) contrast media phase. Patients aged <18years, and those with cystic or infiltrative renal tumors (i.e. lymphomas) were excluded. Manual segmentation of the renal tumors was performed by a GU-radiologist on all axial CT slices. A convolutional neural network (UNET) was trained based on the radiologists´ manual segmentations. In an independent validation dataset, the accuracy of the UNETs predictions of renal tumor contours was compared to the references standard of manual segmentations and quantified using the DICE score. RESULTS: A total of n=394/ n=350 patients with renal tumors imaged in CM /NG phase, respectively, were included (median age 66y; 35% female; median tumor diameter 5.4cm). CT-studies from >20 radiological imaging centers were included with different imaging protocols and slice thickness. The UNET was trained on n=316 CM and n=294 NG contrast phase patients (n=7019 / n=6859 separate CT images). In the independent validation dataset (n=78 / n=56 patients with 1713 / 1298 CT images), the UNET achieved a DICE score of 0.88 and 0.90 for the corticomedullary and nephrogenic CM phase, respectively. The UNET predictions were visualized using a tile-based approach with color-coding and contour-lines that could be overlaid on CT-images to depict varying levels of prediction confidence. CONCLUSIONS: A UNET AI-approach yields a robust automatic delineation of renal tumors on CT-images acquired in clinical routine, irrespective of the contrast media phase. Using color-coding and contour-lines that could be overlaid on original CT-images provides an explainable approach to the UNETs predictions and might improve AI-acceptance in clinical practice. Source of Funding: This study received funding by the 2022 ESR Research Seed Grant. The 2022 ESR Research Seed Grants were kindly supported by an unrestricted, non-exclusive grant from GE Healthcare © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e667 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Annemarie Uhlig More articles by this author Sophie Bachanek More articles by this author Paul Romario Würzberg More articles by this author Manuel Nietert More articles by this author Lutz Trojan More articles by this author Joachim Lotz More articles by this author Johannes Uhlig More articles by this author Expand All Advertisement PDF downloadLoading ...

Cystic MED15::TFE3 translocation renal cell carcinoma: histologic mimicker of multilocular cystic renal neoplasm of low malignant potential with review of the literature

Presented are four cystic renal masses which harbored a MED15::TFE3 gene fusion detected by RNAseq, mimicking multilocular cystic neoplasm of low malignant potential. Clinicopathologic and outcomes data were collected for all cases. Radiologically, three cases were diagnosed as complex cystic masses and one case as a renal cyst, three years prior to surgery. The tumors ranged in size from 1.8 to 14.5cm. Grossly, all masses were extensively cystic. Microscopically, cells with a clear or minimally granular cytoplasm and nuclei with inconspicuous nucleoli lined the cysts' septa. Focally, small mass-forming aggregates of malignant cells were present between septae and were associated with psammomatous calcifications. In case one, apparent prior cyst wall rupture was associated with reactive changes and cystic spaces filled with fibrin clots. Two of the tumors were staged as T1a, one as T1b, and the other as T2b. By immunohistochemistry, the tumors were positive for TFE3, MelanA, and P504S, with apical CD10 while CAIX and CK7 were negative. RNA sequencing was performed on all cases revealing a MED15::TFE3 gene fusion. The patients were alive and without evidence of disease 11-49 months (mean 29.5) after partial nephrectomy. To date, 12 of the 15 MED15::TFE3 fusion renal cell carcinomas published in the literature are cystic, with three being extensively cystic. Thus, if a multilocular cystic renal neoplasm is encountered in a kidney specimen, translocation renal cell carcinoma should be included in the differential diagnosis as cystic MED15::TFE3 tRCCs carry an uncertain prognosis making recognition for future characterization necessary.

Role of multiparametric MRI in characterization of complicated cystic renal masses

BackgroundBosniak classification improves sensitivity and specificity for malignancy among cystic renal masses characterized with MRI. The quantitative parameters derived from diffusion-weighted imaging, and contrast enhancement, can be used in distinguishing between benign and malignant cystic renal masses.MethodsThis prospective observational study included 58 patients (39 male and 19 female) with complicated cystic renal mass initially diagnosed by US or CT. All patients underwent multiparametric MRI study (Pre- and Post-Gd-enhanced T1WI, T2WI and DWI) by using 3 Tesla MRI scanner. Each cystic renal lesion was assigned a category based on Bosniak classification. Demographic data were recorded. ADC ratio, dynamic enhancement parameters in both corticomedullary and nephrographic phases as well as absolute washout were calculated and compared using ROC curve analysis.ResultsThe sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the multiparametric MRI in categorization of cystic renal masses according to Bosniak classification version 2019 were 90.32%, 100%, 100%, 90% and 94.83%, respectively, which was higher compared to biparametric MRI and conventional MRI.ConclusionsMultiparametric MRI can be utilized to confidently evaluate cystic renal masses, overcoming the traditional limitations of overlapping morphological imaging features. Quantitative parameters derived from multiparametric MRI allow better evaluation of complex cystic renal tumors to distinguish between benign and malignant complex cystic renal lesions.

Clear cell renal cell carcinoma with cystic component similar to multilocular cystic renal neoplasm of low malignant potential: a rare pattern of cyst-dependent progression from multilocular cystic renal neoplasm of low malignant potential

BackgroundFor clear cell renal cell carcinoma (ccRCC) with cystic component similar to multilocular cystic renal neoplasm of low malignant potential (MCRN-LMP) and solid low-grade component simultaneously, we propose the designation “ccRCC with cystic component similar to MCRN-LMP” and to study the relationship between MCRN-LMP and it.MethodsTwelve cases of MCRN-LMP and 33 cases of ccRCC with cystic component similar to MCRN-LMP were collected from 3,265 consecutive RCCs to compare them in clinicopathological features, immunohistochemical findings (PAX8, CA-IX, CK7, Vimentin, CD10, P504s, TFE3, 34βE12) and prognosis.ResultsThere was no significant difference in age, sex ratio, tumor size, treatment, grade and stage between them (P > 0.05). All ccRCCs with cystic component similar to MCRN-LMP coexisted with MCRN-LMP and solid low-grade ccRCCs, and MCRN-LMP component ranged from 20 to 90% (median, 59%). The positive ratio of CK7 and 34βE12 in MCRN-LMPs and ccRCCs’ cystic parts was significantly higher than that in ccRCCs’ solid parts, but the positive ratio of CD10 in MCRN-LMPs and ccRCCs’ cystic parts was significantly lower than that in ccRCCs’ solid parts (P < 0.05). There was no significant difference of all immunohistochemistry profiles between MCRN-LMPs and ccRCCs’ cystic parts (P > 0.05). No patient developed recurrence or metastasis.ConclusionsMCRN-LMP and ccRCC with cystic component similar to MCRN-LMP have similarity and homology in clinicopathological features, immunohistochemical findings and prognosis, and form a low-grade spectrum with indolent or low malignant potential behavior. The ccRCC with cystic component similar to MCRN-LMP may be a rare pattern of cyst-dependent progression from MCRN-LMP.

Angiomyolipoma with epithelial cysts, an unexpected discovery in a gunshot abdomen: a single case report

BackgroundAngiomyolipoma with epithelial cysts is a rare variant of an angiomyolipoma that typically occurs sporadically. Patients with pre-existing kidney lesion or disease have significantly increased risk of morbidity and mortality associated with trauma. Abnormal and diseased kidneys are frequently injured by low or insignificant velocity impacts. The vulnerability of these kidneys is related to the type of pathology. However, cystic or hydronephrotic kidneys are more susceptible to trauma. Recent studies have shown an association of this rare entity with tuberous sclerosis complex. Despite the rarity of genetic association of Angiomyolipoma with epithelial cysts and tuberous sclerosis, the emerging findings raise the necessity of genetic testing of these lesions to confirm a remote possibility of tuberous sclerosis complex.Case presentationWe report a case of a 38-year-old male patient who sustained a right renal injury as a result of a gunshot to the abdomen and underwent an emergency nephrectomy due to hemodynamic instability. A grossly looking shattered kidney was surgically removed. The morphology in conjunction with immunohistochemistry of the specimen favoured a diagnosis of Angiomyolipoma with epithelial cysts.ConclusionThis is the first reported case of angiomyolipoma with epithelial cysts diagnosed on a nephrectomy specimen from renal trauma. We aim to highlight an approach to renal trauma on a kidney with pre-existing AMLEC as well as an approach to adult cystic renal neoplasms and to propose the importance of genetic testing for Tuberous Sclerosis.

Deep learning and radiomic feature-based blending ensemble classifier for malignancy risk prediction in cystic renal lesions

BackgroundThe rising prevalence of cystic renal lesions (CRLs) detected by computed tomography necessitates better identification of the malignant cystic renal neoplasms since a significant majority of CRLs are benign renal cysts. Using arterial phase CT scans combined with pathology diagnosis results, a fusion feature-based blending ensemble machine learning model was created to identify malignant renal neoplasms from cystic renal lesions (CRLs). Histopathology results were adopted as diagnosis standard. Pretrained 3D-ResNet50 network was selected for non-handcrafted features extraction and pyradiomics toolbox was selected for handcrafted features extraction. Tenfold cross validated least absolute shrinkage and selection operator regression methods were selected to identify the most discriminative candidate features in the development cohort. Feature’s reproducibility was evaluated by intra-class correlation coefficients and inter-class correlation coefficients. Pearson correlation coefficients for normal distribution and Spearman's rank correlation coefficients for non-normal distribution were utilized to remove redundant features. After that, a blending ensemble machine learning model were developed in training cohort. Area under the receiver operator characteristic curve (AUC), accuracy score (ACC), and decision curve analysis (DCA) were employed to evaluate the performance of the final model in testing cohort.ResultsThe fusion feature-based machine learning algorithm demonstrated excellent diagnostic performance in external validation dataset (AUC = 0.934, ACC = 0.905). Net benefits presented by DCA are higher than Bosniak-2019 version classification for stratifying patients with CRL to the appropriate surgery procedure.ConclusionsFusion feature-based classifier accurately distinguished malignant and benign CRLs which outperformed the Bosniak-2019 version classification and illustrated improved clinical decision-making utility.

Histopathological Evaluation of Malignant Adult Renal Tumors-A Study of Specialized Tertiary Care Center

Background: According to the recent World Health Organization (WHO), renal cell carcinomas (RCCs) that primarily affect adults and 2.2% of all new malignancies and 1.8% of all cancer deaths. Majority of the cases, the diagnosis of RCCs and its subtype can be based on histomorphological evaluation. Accurate pathological classification along with staging and grading of the tumor are necessary for prognosis and various therapeutic options. Materials and Methods: It was a retrospective observational study. This study conducted in histopathology department of the Center for Kidney Disease &amp; urology (CKD &amp; Urology) Hospital, Dhaka, Bangladesh. The study period was eight month from February 2021 to September 2021. The specimens were both partial and total nephrectomy sample of more than 38 years of aged patients. Results: Total 62 nephrectomy specimens were received. Fifty seven (57) cases were malignant tumor and five cases were benign lesions. Majority of malignant tumor consisting of clear cell type renal cell carcinoma 37 (64.91%), followed by papillary type 12 (21.05%), Chromophobe (8.77%), two cases (3.5%) were sarcomatoid cell type and one case (1.75%) of Multiloculated Cystic Renal Neoplasm was noted. Renal cell carcinoma was seen in age range of 38 to 78years with 32 (56.14%) patients more than 50 years of age. Total 42 (73.68%) cases were ISUP Grade 1 and 2 and majority cases were (66.66%) presented at AJCC stage (pT2). Conclusion: In conclusion we observed significant increased clear cell type renal cancer in our institution based population. There was similar male to female ratio, mean tumor size as well as Grade 1, 2 and Stage pT 2 as compared to other studies.

HISTOPATHOLOGIC FEATURES OF KIDNEY TUMORS AND COMPARISON OF PATIENTS TREATED WITH RADICAL AND PARTIAL NEPHRECTOMY AT OSIJEK UNIVERSITY HOSPITAL CENTER FROM 2017 UNTIL THE END OF 2021.

The objective of this study was to present results of kidney tumor treatment at Osijek University Hospital Center over a 5-year period and to compare the outcomes between patients treated with radical nephrectomy (RN) and partial nephrectomy (PN). From November 2016 until the end of 2021, there were 280 consecutive PNs and RNs included in this cross-sectional study. Exclusion criteria were nephrectomies due to non-oncologic reasons and transitional cell carcinoma. There were 229 RNs and 51 PNs, median age of all patients was 62.5 (range 34-84) years. In the RN group, there were 197 renal cell carcinomas (RCC), predominantly clear-cell subtype, while among others there were 8 multilocular cystic renal neoplasms of low malignant potential (MCRNLMP) and 6 oncocytomas and angiomyolipomas each. There were 44 RCCs, 4 oncocytomas, 1 MCRNLMP and 2 cysts removed with PN; median R.E.N.A.L. score was 5. RN group had greater tumor diameters and higher tumor grade, higher postoperative creatinine levels and complications of higher grade. There was no difference in median hospital stay (6 days) and follow-up (20 months). With regard to oncologic safety, preservation of kidney function and lower overall morbidity, PN should be preferred to RN whenever oncologically safe and technically feasible.

Pathological report and prognostic meaning of Bosniak IV cysts: results from a contemporary cohort.

Surgery is the recommended treatment for Bosniak IV renal cysts. We performed a retrospective analysis of Bosniak IV lesions surgically removed to increase evidence on their prognostic meaning. Patients with a Bosniak IV cyst were considered. A contrast-enhanced computed tomography (CT) scan or magnetic resonance imaging (MRI) detected a solid component with contrast enhancement. In no case a percutaneous biopsy was performed. A radical (9, 21.4%) or partial (33, 78.6%) nephrectomy was performed with laparoscopic (14, 33.3%) or robot-assisted (28, 66.7%) approach. Analysis of the final pathology was performed, and recurrence rate was assessed. 42 patients were included. Median lesion size was 54.7 mm (IQR 20.0-81.2). A solid tumour was detected in 40 patients (95.2%), whereas in 2 cases (4.8%) a benign cyst without neoplastic component was diagnosed. Final pathology revealed a low-grade clear cell renal cell carcinoma (ccRCC) in 16 cases (38.0%), a multilocular cystic renal neoplasm of low malignant potential in 6 cases (14.3%), a low-grade papillary RCC (pRCC) type I in 4 cases (9.5%), a clear cell papillary RCC (ccpRCC) in 10 cases (23.8%) and an oncocytoma in 2 cases (4.8%). A high-grade ccRCC was detected in 2 cases (4.8%), whereas no patients had a pRCC type II. In all cases surgical margins were negative. Median follow-up was 24 months and no recurrence occurred. Our results increase evidence on the favourable pathology and good prognosis of Bosniak IV renal cysts, supporting the role of surgery as a definitive treatment and suggesting the need for a low-intensity follow-up.

Renal Cell Carcinoma Grossly Presenting as Cystic Lesions: A Series of Four Cases

Kidney cancer currently ranks as the seventh most common cancer in men and the tenth most common in women. Clear-Cell Renal Cell Carcinoma (CCRCC) represents the most common malignancy of the kidney, accounting for 80% of renal carcinomas. Most CCRCC develops in patients aged over 60 years, and the incidence is slightly higher in men than in women. Partial or total nephrectomy cures the majority of patients with CCRCC. In the present discussion, the authors present cases of 4 males with RCC radiographically identified as Space Occupying Lesions (SOL) to warn clinicians that these seemingly solid lesions have a cystic component as well and may harbour underlying malignancy. Grossly, upon cutting the kidney, all four cases showed solid and cystic components, two of which were multiloculated. Histopathological Examination (HPE) revealed three cases of CCRCC and one case of cystic CCRCC. It is difficult to determine preoperatively whether a cyst is malignant based solely on imaging examinations. Regarding disease prognosis, RCC with predominantly cystic components is considered less aggressive than solid RCC. Cystic RCC (CRCC) carries an excellent prognosis following surgical treatment. Partial nephrectomy should be regarded as the preferred surgical technique in the management of CRCC. In conclusion, authors would like to highlight the fact that histopathologists need to be familiar with the different types of RCC presenting with a cystic component, as these have prognostic significance. Clinicians also need to be aware that there are certain caveats in the radiological diagnosis of cystic renal neoplasms, and histopathology may often present a different picture from the radiological diagnosis.

The safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy: a new avenue for the treatment of cystic renal tumors

Purpose Clinically, the management of cystic renal masses is tricky. The study aims to evaluate the safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy (LMAPN) for cystic renal tumors. Methods and materials Between November 2017 and January 2022, LMAPN was performed on 43 patients (29 men and 14 women; age range: 22–80 years; median age 54 years) with Bosniak category III (n = 15) or IV (n = 28) cystic renal tumors (size range: 1.2–5.0 cm; mean size 2.8 cm). The median follow-up period was 26 months (range: 7–56 months). Baseline and perioperative data, pathological features, renal function, postoperative complications and oncologic outcomes were collected and evaluated. Results Forty-three cystic renal tumors were successfully managed by LMAPN. The mean operating time was 79 min (range: 40–130 min). The mean time of renal pedicle clamping was 19 min (range: 12–25 min). Mean intraoperative blood loss was 28.4 mL (range: 10–80 mL). The mean postoperative hospitalization duration was 4 days (range: 2–6 days). Negative surgical margins were diagnosed in all cases. During the follow-up, no patient appeared with distant metastasis, wound or peritoneal cavity implantation. No major but minor complications of Clavien–Dindo grade I were encountered after the operation. The 1-, 3- and 4-year overall survival rate was 100%, 96.6% and 88.5%, respectively. Conclusion This is the first study focusing on LMAPN for cystic renal tumors, demonstrating its favorable feasibility, safety and disease control. Long-term follow-up is necessary to draw conclusions on the preference and advantages of the new therapeutic approach.

Implication of cystic fluid cytology of renal cell carcinoma on surgical practice

ObjectivesTo evaluate the incidence of positive cystic fluid cytology and its risk factors in cystic renal cell carcinoma (RCC) addressing its implication on the current surgical practice.MethodsAll clinically diagnosed Bosniak III, IV cystic renal masses from March 2019 to August 2022 were studied prospectively. Database of patients’ demographics and cystic tumor characteristics were recorded. Partial or radical nephrectomies were performed by either laparoscopic or robotic approach. Cystic fluid was collected right after specimen retrieval in the surgical field and examined by pathologist. Cytology results were compared to the demographic, perioperative variables using univariate and multivariate analysis.ResultsA total of 70 patients of histologically confirmed cystic RCC were included. Sixty seven patients underwent radical nephrectomy with laparoscopic or robotic approaches, while 3 patients underwent radical nephrectomy. There was no intraoperative cystic rupture or fluid spillage. Positive cystic fluid cytology findings were identified in 34 (48.6%) patients, while negative cystic fluid cytology were identified in 36 (51.4%) cases. Definite malignant cells were observed in 28 patients while the other six patients showed highly suspicious atypical cells. Histologically, 24 (70.8%) patients were proven clear cell RCC and 25 (73%) showed Fuhrman grade 1 or 2 in final histologic review in positive group. Univariate and multivariate regression analysis between positive and negative cytology groups showed that the presence of the malignant cells in cystic fluid was significantly associated with patients’ age (> 55 years) and Bosniak grade of cystic tumor (p < 0.05).ConclusionsDefinite malignant cells in cystic fluid cytology were observed through our study. Additionally, patients’ age (> 55 years) and Bosniak grade were the significant risk factors of positive cytology in cystic RCC. Therefore, necessity of meticulous manipulation of cystic renal tumors, despite their clinical features, should not be underemphasized to avoid the least possible tumor cell seeding in case of cystic rupture when operating such high risk of positive cytology.

Multilocular cystic renal cell carcinoma of low malignant potential- A rare case report

Multilocular cystic renal neoplasm of low malignant potential (MCRCC) by definition is "Neoplasm composed entirely of numerous cysts, the septa of which contain individual or groups of clear cells without expansile growth" according to WHO 2016 classification. In 2016 WHO separates this neoplasm of low malignant potential from cystic renal cell carcinomas which have some overlapping morphologic features. Tumor exibits low stage and low -grade characteristics and is a special type of RCC. We report this case in a 49 year old male patient for its rarity and also to know the importance of it to identify and differentiate from its mimicks.

A Rare and Unusual Renal Tumour: A Case Report

Introduction: Multilocular cystic renal cell neoplasm of low malignant potential is a rare histologically identified form of clear cell renal cell carcinoma included in 2016 Renal tumour classification of WHO. It is a low risk neoplasm with clear cells that have less expansile proliferation than other clear cell variants of renal cell carcinoma with no recurrence and metastasis with few exceptional cases. The incidence of multilocular cystic renal cell carcinoma is estimated to be 1-2 percent.6,12 Although the WHO classification of multilocular cystic renal cell carcinoma with low malignant potential was reported in 2004. The WHO 2016 categorization of renal cell tumour has been assessed as a special entity with no documented cases of metastasizing and recurrent tumour development.4 We present a rare clinical case of multilocular cystic renal cell neoplasm with low malignant potential, which should not be mistaken with other differential diagnoses such as cystic necrosis in conventional renal cell carcinoma, tubulo cystic renal cell carcinoma, multilocular cystic nephroma, clear cell variant of renal cell carcinoma and other benign multilocular renal tumors.

Cystic Renal Cell Carcinoma – Sometimes A Diagnostic Dilemma: A Case Report on Rare Multilocular Cystic Renal Cell Carcinoma

Cystic renal tumors often create diagnostic dilemma. It might be a cancer in a complex cyst, cystic degeneration of a renal cell carcinoma, Papillary cystic renal cell carcinoma or multilocular cystic renal cell carcinoma (MCRCC). MCRCC is a rare cystic tumor of the kidney. It is recognized as a separate subtype of renal cell carcinoma in WHO classification of adult renal tumors in 2004 with excellent prognosis. A 47 years old male presented with an incidentally detected large right renal cystic lesion in the upper and hilar region. After discussion with the patient about the possibilities, right radical nephrectomy was performed. Histopathology was done by one of the renowned Pathologists of the country and was reported as a rare variety Multilocular Cystic Renal Cell Carcinoma. It is very important to differentiate this type of cystic renal cell carcinoma from cystic degeneration of conventional RCC. Bangladesh J. Urol. 2021; 24(2): 224-228

Böbrek Tümörlü Hastalarda Histopatolojik Prognostik Veriler Açısından İleri Yaşın Öneminin Değerlendirilmesi

Kidney tumors are more common in males, and are often considered to be in the category of older-age tumors. In this study, it was aimed to evaluate the importance of age in terms of histopathological prognostic data for kidney tumors, with many defined histopathological prognostic parameters. Twenty–four patients &amp;gt;75 years, who were diagnosed with kidney cancer with nephrectomy between 2010 and 2020, were included in study. The relation between histological features as histological subtype, grade of the tumor, presence of lymphovascular, perineural, hilar and perirenal adipose tissue invasion, necrosis, and the state of surgical margins were determined. Twenty-three tumor samples were classified as renal cell carcinoma (RCC). One sample was classified as multilocular cystic renal cell neoplasm with low malignancy potential. The histopathological subtypes of RCC were; clear cell RCC (n=19), chromophobe RCC (n=2), Type 1 papillary RCC (n=1), and Type 2 papillary RCC (n=1), respectively. Among the histopathological data, renal vein invasion showed statistical significance in terms of survival (p=0.002). In addition, a significant relationship was observed between increasing tumor grade and LVI (p=0.009). Tumor size, and grade, presence of necrosis, lymph node metastasis, perirenal adipose tissue and renal vein invasion are among the prognostic markers for RCC. However, in our series of advanced age cases, only renal vein invasion was found to be prognostic for survival, while other identified markers did not have a significant effect on this age group. This phenomenon indicates that advanced age tumors may differ from tumors in other ages, and the data used routinely may therefore be insufficient to predict the course of the disease.

Pediatric Cystic Nephroma with a Review of the Literature

Cystic renal neoplasms have a broader spectrum that includes benign and malignant tumours: benign multilocular cyst, multilocular cystic renal cell cancer and cystic renal cell cancer. Gross similarities in the clinical and radiological imaging findings may cause conflict in their exact diagnosis and further treatment. Cystic nephroma is a rare, non-hereditary benign, multilocular cystic lesion of the kidney and has a prevalence in males. It has bimodal presentation more prevalent in males. In this case patient with cystic nephroma presents with a painless, progressively increasing abdominal lump, which was diagnosed and then operated. Thus, it is crucial to narrow the diagnosis by radiological imaging for preoperative planning and proper management. Abbreviations: UTI: Urinary Tract Infections, CN: Cystic Nephroma, MLCN: Multilocular Cystic Nephroma, CPDN: Cystic Partially Differentiated Nephroblastoma

Comparison of survival between unilocular cystic and purely solid renal cell carcinoma

To evaluate clinicopathological features and survival outcomes of unilocular cystic renal cell carcinoma (ucRCC) compared with purely solid renal cell carcinoma (sRCC), and to evaluate the oncologic aggressiveness of ucRCC. The relevant data of 957 patients with sporadic unilateral renal cell carcinoma (RCC) underwent surgical treatment in 2 institutions from Jan 2014 to Oct 2018 were obtained. We excluded multilocular cystic renal neoplasm of low malignant potential (MCRNLMP), RCC with multilocular cysts and necrotic RCC. 74 ucRCCs were identified by pathology reports. We performed propensity score matching (PSM) and eventually selected 144 sRCCs. The clinicopathological features and survival outcomes were compared properly. After PSM, age, BMI, Charlson Comorbidity Index, and postoperative Chronic Kidney Disease grade were not significantly different. Both overall survival and progression-free survival of ucRCC were significantly better than sRCC by the log-rank test. Twenty-five cases of sRCCs were in the pT3 or pT4 stage, while no pT3 or pT4 tumors were found in ucRCCs. Fuhrman grade and lymphatic metastasis were found to be significant prognostic factors for the overall survival of ucRCC. Unilocular cystic RCC has a lower Fuhrman grade and pathological stage and a better prognosis compared with solid RCC. Patients with ucRCC still probably have lymphatic metastasis at surgery and may have postoperative metastasis, which is different from MCRNLMP. We recommend that the diagnosis of ucRCC should be reflected in pathology report. Different subtype of cystic RCC should be taken into consideration in counseling and management.

Clear Cell Papillary Renal Cell Tumors: A Study of 42 Tumors with Emphasis on the Fibrous Capsule, Cystic Component, and GATA3 Immunohistochemistry.

Clear cell papillary renal cell tumor is a common and sometimes underdiagnosed renal cell neoplasm. Its proper recognition is important because its diagnosis implies a remarkably high probability of indolent behavior. This study aimed to evaluate the frequency of a fibrous capsule, a cystic component, and a GATA3 expression in clear cell papillary renal cell tumors. We assessed 419 renal cell neoplasms from three institutions located in northeastern Brazil and identified 42 clear cell papillary renal cell tumors (from 39 patients), which were the fourth most common renal cell neoplasm. These tumors commonly exhibited fibrous capsules (all showed complete or partial capsules) and cystic component (93%). Eighteen out of 42 tumors (43%) showed some expression of GATA3, and weak and focal staining was common among the positive tumors. Clear cell papillary renal cell tumor must always be included in the differential diagnosis of predominantly cystic renal cell neoplasms. As GATA3 is inconsistently expressed in clear cell papillary renal cell tumors, it is not useful in this diagnosis.