Multilocular Cystic Renal Cell Carcinoma Research Articles

Multilocular Cystic Renal Neoplasm of Low Malignant Potential - A Rare Case Report with Literature Review

Multilocular cystic renal cell carcinoma or multilocular clear cell renal cell carcinoma is a rare type of cystic neoplasms of kidney. MCRCC comprises 1-2% of all renal tumors. MCRCC has well defined diagnostic criteria, has low stage The term MCRCC was renamed as MCRNLMP by ISUP in 2013.Only few cases of MCRCC are reported in literature till now We report a rare case of MCRCC / MCRNLMP in 52 years female presented with chief complaints of pain and dragging sensation in the right side of abdomen for 1 year. Keywords: Multilocular, cystic, renal cell carcinoma, nephrectomy, low malignant potential

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

A Comprehensive Commentary on the Multilocular Cystic Renal Neoplasm of Low Malignant Potential: A Urologist's Perspective.

Simple SummaryMultilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a cystic renal neoplasm with an excellent prognosis. This neoplasm was previously named as “multilocular cystic renal cell carcinoma”, which is now considered obsolete. In 2016, the WHO distinguished this neoplasm of low malignant potential from cystic renal cell carcinomas, which have some overlapping morphologic features.Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a cystic renal tumor with indolent clinical behavior. In most of cases, it is an incidental finding during the examination of other health issues. The true incidence rate is estimated to be between 1.5% and 4% of all RCCs. These lesions are classified according to the Bosniak classification as Bosniak category III. There is a wide spectrum of diagnostic tools that can be utilized in the identification of this tumor, such as computed tomography (CT), magnetic resonance (MRI) or contrast-enhanced ultrasonography (CEUS). Management choices of these lesions range from conservative approaches, such as clinical follow-up, to surgery. Minimally invasive techniques (i.e., robotic surgery and laparoscopy) are preferred, with an emphasis on nephron sparing surgery, if clinically feasible.

Incidentally detected multilocular cystic renal cell carcinoma: a case report

Multilocular cystic renal cell carcinoma (RCC) is a tumor of low-grade malignant potential which is curable by surgical resection. Here, we report a case which was incidentally detected during evaluation of right flank pain. It’s very challenging to differentiate such lesions from conventional clear cell carcinoma. However, it has good prognosis and amenable to surgical resection.

A controlled clinical study of a two-trocar mini-laparoscopic technique versus the standard laparoscopic technique in treatment of adult renal cysts.

IntroductionLaparoscopic renal cyst decortication is currently the best choice for the treatment of simple renal cysts and is widely used in clinical practiceAimTo investigate the safety and clinical efficacy of two-trocar mini-laparoscopic decortication of adult renal cysts.Material and methodsA total of 90 patients were enrolled in the study and randomly divided into two groups: a two-trocar mini-laparoscopic treatment group (M group) and a three-trocar standard laparoscopic treatment group (S group), with 45 patients in each group.ResultsThe average length of hospital stay was shorter, and the demand for postoperative analgesics was less in the M group than in the S group (p < 0.05). The proportion of “very satisfied” patients in the patient physical recovery satisfaction survey was significantly higher in the M group than in the S group (p < 0.05). Of the 45 patients in the M group, 40 successfully underwent surgery. In 3 patients, the two-trocar procedure was converted to a three-trocar procedure due to difficulty in separating perirenal adhesion for visualization. Mini-laparoscopic surgery was converted to classic laparoscopic surgery in 2 patients. In the S group, 44 patients successfully underwent the renal cyst decortication procedure. One patient underwent partial renal resection due to an intraoperative diagnosis of multilocular cystic renal cell carcinoma. Postoperative urine leakage was reported in 3 patients in the M group and two in the S group.ConclusionsTwo-trocar mini-laparoscopic treatment of renal cysts is as safe and effective as traditional laparoscopy but is associated with less cosmetic damage, leading to a better physical appearance.

Multilocular cystic renal neoplasm-low malignant potential (MCRN-LMP) - review

Multilocular Cystic Renal Neoplasm of Low Malignant Potential (MCRN-LMP), previously known as multilocular cystic renal cell carcinoma as a rare variant of cystic kidney. It is composed of multiple cysts separated by thin septa covered with clear cells with no expansile growth. The termMCRN-LMPshould be used exclusively to identify a cystic kidney lesion with a small clusters of neoplastic clear cells in the cyst walls. Clinically these cases may present with flank pain or the majority of these tumors are incidentally found on radioimaging. Grossly, the tumor is well demarcated and consists of multiple various-sized cysts. The fibrous septa are generally thin and there is no discernible expansile nodule. The WHO/ISUP nuclear grade is generally low and usually corresponds to grade 1 or 2. In the World Health Organisation (WHO) 2016 classification of kidney tumors recognizes MCRN-LMP as a rare variant of cystic kidney. MCRN-LMP generally exhibits a low stage of TNM classification. These tumors have a favorable clinical course. The clinical course of these lesions suggests that patients may benefit from nephron-sparing surgery. The aim of this review is to bring attention, that MCRN-LPM is a low aggressive neoplasm with no recurrence and no metastatic potential. The updated diagnostic modalities and conservative line of management may be applicable for this rare entity for the better care of patients.

PD-L1 expression and infiltration by CD4+ and FoxP3+ T cells are increased in Xp11 translocation renal cell carcinoma and indicate poor prognosis.

Interaction between programmed death-1 ligand (PD-L1) and its receptor programmed death 1 (PD-1) on T cells inactivates antitumour immune responses. PD-L1 expression has been associated with poor prognosis in renal cell carcinoma (RCC) and predicts adverse outcome. This study was designed to evaluate the impact of PD-L1 expression and the immune microenvironment on the clinical outcome in Xp11 translocation renal cell carcinoma (TRCC) and, therefore, their potential relevance as prognostic biomarkers. The present retrospective analysis investigated expression of PD-L1 and immune cells CD8, CD4, CD3, forkhead box protein 3 (FoxP3) and PD-1 in TRCC compared to other types of RCC. FFPE specimens were collected between 2011 and 2017 from 311 patients who underwent nephrectomy at our institution for RCC. Specimens were immunostained for PD-L1, CD8, CD4, CD3, FoxP3 and PD-1, and an outcome analysis was conducted. PD-L1 expression rate was highest in TRCC (68%, 16 of 25), followed by mucinous tubular and spindle cell RCC and collecting duct carcinoma (33%, one of three), papillary RCC (27%, seven of 26), clear cell RCC (16%, 29 of 233), chromophobe RCC (11%, two of 18) and multilocular cystic RCC (0%, none of three). In TRCC, PD-L1 expression was associated with poor recurrence-free survival (RFS) (P=0.041). The CD4high and FoxP3high groups showed a significantly shorter RFS (P=0.05 and P=0.031, respectively) compared to CD4low and FOXPlow groups. PD-L1 expression was higher in TRCC than in other types of RCC. High PD-L1 tumour cell expression and tumour infiltration by CD4+ and FoxP3+ immune cells were associated with poor RFS in TRCC.

Synchronous Metastasis Rates in T1 Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results Database–based Study

BackgroundSynchronous metastasis (SM) rates in T1 renal cell carcinoma (RCC) patients relied on historical cohorts and may not take into account the favorable stage migration toward lower tumor size (TS) that occurred in more recent years. ObjectiveTo investigate SM rates in T1 RCC patients according to histological subtype (HS), tumor grade (TG), and TS. InterventionPartial nephrectomy, radical nephrectomy, focal ablation, and non-interventional management. Outcome measurements and statistical analysisWithin the Surveillance, Epidemiology, and End Results database (2004–2015), 60 640 stage T1 patients were identified. SM rates were tabulated and tested in multivariable logistic regression models. Results and limitationsAccording to HS, average SM rates were 0%, 0.5%, 1.1%, 1.4%, 3.7%, 21.5%, and 36.2% for multilocular cystic, chromophobe, papillary, clear cell TG 1–2, clear cell TG 3–4, collecting duct, and sarcomatoid RCC, respectively. In a multivariate logistic regression model, age, TS, HS, and TG were independent predictors of SM. Bone only was the commonest metastatic site (41.0%), followed by lung only (24.5%), liver only (3.6%), and brain only (3.8%). Of all SM patients, 72.8% harbored a single metastatic site. The major limitations of this study are lack of recurrence and metastatic progression data. ConclusionsWithin T1 RCC, it was possible to identify five metastatic risk categories according to SM rates: (1) multilocular cystic RCC (0%), (2) chromophobe RCC (0–2.0%), (3) clear cell TG 1–2 and papillary RCC, (4) clear cell TG 3–4 RCC (1.2–8.9%), and (5) sarcomatoid and collecting duct RCC (7.0–49.1%). The most frequent metastatic location is bone only, followed by lung only, and virtually all SMs are solitary. Patient summaryMetastatic rate varies in T1 stage renal cell carcinoma patients according to tumor size, histology, and tumor grade.

Immunohistological Diagnosis of Primary and Metastatic Renal Cell Carcinoma Using Panel of Immunohistochemical Markers

Background: Tumour heterogeneity and lack of markers with high specificity makes diagnosis of renal cell carcinoma (RCC) challenging. The study was undertaken to evaluate panel of IHC markers to enable diagnosis and reproducible classification in primary and metastatic renal tumors. Methods: Descriptive Study wherein 100 cases of RCC and 25 trucut biopsies (20 metastatic and 5 primary renal tumors) were evaluated for morphology and immunostained by panel of immunohistochemical (IHC) markers consisting of CA-9, CD10, CK-7, AMACAR and TFE-3 with additional markers as required. Result: Morphologically tumors were grouped as clear cell and nonclear cell (eosinophilic and poorly differentiated). Clear cell RCCs (CCRCC), clear cell papillary RCC (CCPRCC) and multilocular cystic RCC (MCRNLMP) displayed strong statistical association of CA-9 immunostaining (p=50.00, x2-0.000). Inverse correlation was found between the intensity of the staining of CA-9 and tumor grade. (p=32.97, x2=0.000). CA-9 and CK-7 co-expression was evident in all cases of CCPRCC and MCRNLMP. Papillary RCC exhibited positive statistical correlation with CK-7 and AMACAR. E-cadherin and CD117 were required additionally to differentiate between oncocytoma and chromophobe RCC. CD10 and Pax 8 were most helpful in diagnosing metastatic RCCs Conclusion: IHC panel consisting of CA-9, CD10, CK7, AMACR and TFE3 helps triage RCCs with clear cell/eosinophilic cell / papillary/poorly differentiated pattern. In a setting of metastatic RCC, use of CD10 and Pax 8 together facilitate primary diagnosis of RCC when tissue available is limited.

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.

Magnetic Resonance Imaging Findings of Multilocular Cystic Renal Cell Carcinoma and Clinical-pathologic Comparison

Magnetic Resonance Imaging Findings of Multilocular Cystic Renal Cell Carcinoma and Clinical-pathologic Comparison

Ancillary studies in fine needle aspiration of the kidney.

An increasing number of renal cell carcinomas (RCCs) require ancillary studies for diagnosis. The majority of renal fine needle aspirates do not require ancillary studies. Among the most common useful stains are cytokeratin 7 (separating clear cell RCC [negative] from papillary RCC, clear cell papillary RCC, and multilocular cystic RCC [positive] as well as separating chromophobe RCC [diffusely positive] from oncocytoma [focally positive/negative]) and CD117 (separating chromophobe RCC and oncocytoma [positive] from granular variants of clear cell RCC [negative]). CD68 and keratin are helpful in distinguishing RCC from xanthogranulomatous pyelonephritis. HMB45 is useful in recognizing scant aspirates of angiomyolipoma. Less common subtypes of RCC may benefit from the use of more specialized ancillary studies (succinate dehydrogenase B, fumarate hydratase, tumor suppressor gene INI, OCT3/4). While the majority of renal fine needle aspirates can be accurately diagnosed based on morphology alone, improved subtyping and accuracy can be achieved with the use of immunohistochemical and molecular studies. Cancer Cytopathol 2018;000:000-000. © 2018 American Cancer Society.

An Easy and Effective Method to Locate Renal Vein During Retroperitoneal Laparoscopic Radical Nephrectomy: Single-Center Experience.

BackgroundThere are few studies that address how to quickly locate the renal vein after processing the renal artery during retroperitoneal laparoscopic radical nephrectomy (RLRN) for renal cell carcinoma (RCC). This study aimed to evaluate the feasibility of an easy and effective method to locate the renal vein in RLRN.Material/MethodsBetween September 2016 and October 2017, a total of 44 consecutive cases of RLRN were performed. All the surgeries used the proposed study method to locate the renal vein, in which surgeons located the renal artery following the medial arcuate ligament on the posterior abdominal wall, then the surgeon directly searched for the renal vein caudally relative to renal artery when performing left nephrectomy, but cranially when performing right nephrectomy.ResultsAmong the 44 enrolled RLRN patients, there were 28 left nephrectomies and 16 right nephrectomies. We found the renal vein in most cases successfully by our proposed method. The renal vein was located caudally relative to the renal artery in 27 cases of the left kidney (96.4%), and was located cranially in 14 cases of the right kidney (87.5%). The mean operative time was 135.0±27.8 minutes. No intraoperative complications occurred. Postoperative complications (fever) developed in 5 patients. Pathological examination revealed: clear cell carcinoma in 34 cases (77.3%), chromophobe renal cell carcinoma (RCC) in 5 cases (11.4%), papillary RCC in 3 cases (6.8%), multilocular cystic RCC in 1 case (2.3%), and oxyphil cell adenoma in 1 case (2.3%).ConclusionsOur proposed method to search for the renal vein might be a safe and feasible procedure to accelerate the process of handling the renal pedicle and of great practical significance in RLRN surgery.

Частота малигнизации кист почек категорий 1, 2, 2F по классификации BOSNIAK в мультилокулярный кистозный почечно-клеточный рак

Renal cysts remain the most common of benign renal lesions, but current literature is lacking large observational studies on the incidence of their malignant transformation. To assess the incidence of malignant transformation of renal cysts of category 1, 2, and 2F by the Bosniak classification into multilocular cystic renal cell carcinoma. From January 2009 to December 2017, 177 patients with renal cysts of category 1 (n=50), 2 (n=74), and 2F (n=53) underwent laparoscopic decortication. In 10 cases, post-operative histological and immunohistochemical studies revealed foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma. Foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma were detected in 10 (5.65%) patients (five men, five women, mean age 58.9 years). The incidence of malignant transformation of renal cysts of categories 1, 2, and 2F was 0%, 2.7% (2 of 74 patients), and 15.1% (8 of 53 patients), respectively. Subsequently, all ten patients were submitted to surgical treatment: eight of them underwent a partial nephrectomy, and two received a nephrectomy. During a median of 49.3 (31-72) months follow-up, no metastasis, and recurrence of multilocular cystic RCC were observed. A more modern algorithm for managing patients with Bosniak category 1, 2 and 2F cysts need to be developed to establish early surveillance of patients starting with category 1 cysts. Given the low malignant potential of these tumors, they should be treated with organ-sparing surgery.

Nuclear factor-kappa B subunits and their prognostic cancer-specific survival value in renal cell carcinoma patients

Better characterisation and understanding of renal cell carcinoma (RCC) development and progression lead to better diagnosis and clinical outcomes. In this study, expression of nuclear factor-kappa B (NF-κB) subunits: p65 (RelA), p105/p50, p100/p52, and cRel in RCC tissue were compared with corresponding normal kidney, along with tumour characteristics and survival outcome. Ninety-six cases of RCC with paired normal kidney were analysed. Clinicopathological data, demographics and survival data were available. Immunohistochemistry (IHC) for NF-κB subtypes was analysed using the Aperio digital pathology system for overall cellular expression and localisation. The prognostic cancer-specific survival value of the subunits in RCC patients was analysed. Approximately 50% of patients had clinical stage T1, with 22 patients having metastases at presentation. RCC subtypes were: clear cell (n= 76); papillary (n= 11); chromophobe (n= 5); clear cell tubulopapillary (n= 3); and one multilocular cystic RCC. Median follow up was 54.5 months (0.2-135), with 28 deaths at time of analysis. NF-κB p65 had higher overall and nuclear expressions, with lower overall and nuclear expressions of p50, p52 and cRel in RCC compared with normal kidney. Higher expressions of p65 (nuclear), p52 (overall and nuclear) and p50 (overall) correlated significantly with worse cancer-specific survival. This is the first large series of analysis of expression of NF-κB subunits in RCC. Especially with regards to the less studied subunits (p52, p50, cRel), our results allow a better understanding the role of NF-κB in RCC development and progression, and may pave the way for future targeted NF-κB subunit specific therapies.

Predominantly cystic clear cell renal cell carcinoma and multilocular cystic renal neoplasm of low malignant potential form a low-grade spectrum.

Multilocular cystic renal cell carcinoma has been recently excluded from clear cell renal cell carcinoma (CCRCC) category and re-designated as multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) due to its uniformly good outcomes. While strict distinction between MCRNLMP from predominantly cystic CCRCC (pc-CCRCC) is being emphasized, the significance of extensive true cystic component in CCRCC has not been investigated. Herein, we analyzed 57 MCRNLMP, 69 pc-CCRCC, and 46 non-cystic CCRCC. There were no statistically significant differences between the three subtypes in age, gender, and laterality. ISUP grades were 1 (73%) or 2 (27%) for MCRNLMP; for pc-CCRCC were 1 (31%), 2 (60%), and 3 (9%); and for non-cystic CCRCC were 1 (9%), 2 (52%), 3 (26%), and 4 (13%). MCRNLMP were either pT stage 1 (91%) or 2 (9%), pT stages for pc-CCRCC were 1 (92.5%), 2 (1.5%), and 3 (6%) and for non-cystic CCRCC were 1 (58.7%), 2 (6.5%), and 3 (34.8%). None of MCRNLMP patients developed recurrences or metastases, and only 1 contralateral kidney tumor and 1 metastasis developed in pc-CCRCC. In contrast, 19 patients with non-cystic CCRCC developed metastases (5-year PFS 58%, CI 38.3-73.5%), and 1 patient died of disease. Monosomy 3 was common in both MCRNLMP (3/3) and pc-CCRCC (6/7). This large series of MCRNLMP confirms its indolent behavior, shows that pc-CCRCC has significantly better prognosis than non-cystic CCRCC and may define the lower grade spectrum of CCRCC. We recommend that the presence and extent of CCRCC cystic component should be documented in the pathology report.

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.

Multilocular cystic renal cell carcinoma: our experience

Multilocular cystic renal cell carcinoma is now recognized as an independent pattern by WHO; it is a rare malignancy with a predominantly cystic growth, characterized by very low oncologic evolution and then susceptible to conservative treatment. In the kidney cystic masses of different origin may arise, i.e. due to malformation, acquired disease or tumor. Renal neoplastic lesions may have a cystic or pseudocystic component. There are also four types of neoplasm with a predominantly cystic growth, including the multilocular cystic carcinoma, which are macroscopically very similar and impossible to differentiate through diagnostic pre-operative images. The Authors present four cases of multilocular cystic renal cell carcinoma diagnosed in the 2000-2007 period, with special reference to diagnostic difficulties and to pre- and intra-operative features of the neoplasm. In conclusion, the extemporaneous histological preoperative diagnosis of multilocular cystic renal cell carcinoma is not possible because it requires extensive sampling; furthermore, the final histological diagnosis sometimes needs particular immunohistochemical procedures to be confirmed.

Multilocular cystic renal cell carcinoma: A case report and review of the literature

Multilocular cystic renal cell carcinoma (MCRCC), which exhibits low-stage and low-grade characteristics, is a special type of RCC. MCRCC is extremely rare and generally develops at ages >50 years. We herein report a case of MCRCC in a 28-year-old man, which, to the best of our knowledge, is the youngest case reported worldwide to date. The patient presented with irritative bladder symptoms for 1 year. Dynamic enhanced computed tomography (CT) imaging revealed a mass with inhomogeneous enhancement in the left kidney, with a rich blood supply. B-ultrasonography also revealed a renal protruding mass. As the mass was highly suspicious to be a malignant tumor, laparoscopic radical nephrectomy was performed and MCRCC was definitively diagnosed by pathological examination. The patient has been regularly followed up for 6 months, without complications or disease recurrence.