Multilocular Renal Cyst Research Articles

Infected multilocular renal cyst and its challenging approach

Renal cysts are relatively common, increasing in prevalence with age [1-3]. They are usually benign and asymptomatic, with their diagnosis being incidental on imaging exams. In some cases, however, they can reach large dimensions, leading to symptoms and/or complications [3,4].

Infected Multilocular Renal Cyst and its Challenging Approach

An 80-year-old woman with a history of metabolic syndrome, ischemic heart and cerebrovascular disease was admitted at the emergency department with asthenia and left abdominal and flank pain. She was on day 5th of empiric cefuroxime for urinary tract infection. On physical examination, the patient was febrile, but hemodynamically stable; an abdominal mass in the left flank was evident and painful on deep palpation; ipsilateral Murphy's sign was present.

Diagnosis and treatment of cystic nephroma and the mixed epithelial and stromal tumor: 13 cases report

Objective To discuss the characteristics and treatment of the cystic nephroma (CN) and the mixed epithelial and stromal tumor (MESTK).Methods A retrospective collection of the clinical data of 7 CN patients and 6 MESTK patients from Jan.2000 to Apr.2012.In CN cases,there were 3 males and 4 females.Mean age was 50 years (36 to 69 years).Five cases had no symptom and were found by ultrasonic examination.Two patients had lower back discomfort.There were 3 on left side,4 right.The maximum diameter was 1.0 to 8.5 cm.Seven cases were graded as Bosniak Ⅱ by CT scan.Preoperatively 4 were diagnosed as multilocular renal cysts,2 cystic renal cell carcinoma.One case diagnosed as muhilocular renal cyst initially was diagnosed as CN when recurrence.On 6 MESTK patients,there were 1 male and 5 females.Mean age was 38 years (16 to 50 years).Four cases had no symptom and were discovered by ultrasonic examination.Two patients had lower back discomfort.There were 2 cases on left side,4 right.The maximum diameter was 3.4 to 11.0 cm.Five cases were graded as Bosniak Ⅲ and 1 was graded as Bosniak Ⅳ by CT scan.Six patients were all diagnosed as cystic renal cell carcinoma preoperatively.Results In the 7 cases of CN patients,3 accepted retroperitoneal laparoscopic cyst unroofing,2 accepted retroperitoneal laparoscopic partial nephrectomy,1 patient with a preoperative diagnosis of cystic renal cell carcinoma got retroperitoneal laparoscopic radical nephrectomy.One patient recurred 7 years after retroperitoneal laparoscopic cyst unroofing,and underwent open partial nephrectomy.All the 6 MESTK patients underwent retroperitoneal laparoscopic radical nephrectomy.Nine cases were followed up for 15 months to 9 years without recurrence.Conclusions CN and MESTK are rare benign tumors of the kidney.Few MESTK have malignant tendency.Preoperative misdiagnosis is frequent.Multi-cystic lesions with no mural nodules should take CN/MESTK into consideration.Especially when the lesions located convex to the pelvis,it should be highly suspected of CN,and the possibility of partial nephrectomy should be assessed.Cyst unroofing for CN may have risk of recurrence. Key words: Mixed epithelial and stromal tumor of kidney; Cystic nephroma; Diagnosis; Therapy

The diagnostic dilemma of a multilocular renal cyst: a case report

IntroductionRenal cysts presenting in childhood are rare. Historically, renal cysts have been subject to variable nomenclature which has contributed to diagnostic difficulties. They can occur as solitary, unilateral or multiple lesions. Cysts can be further classified according to loculation, communications within the structure and tissue types present.Case presentationWe report the case of a 15-month-old Caucasian boy presenting with abdominal distension as the only clinical symptom. On examination, an ill-defined abdominal mass was found. This was confirmed on ultrasound to be a multiseptated cystic mass with a solid element, arising from the right side of the abdomen. Despite further imaging, the origin of the mass could not be identified. The mass was suspected of malignancy but all blood tests and tumour markers were normal. The mass proved to be a diagnostic challenge. The renal origin of the mass was only confirmed at surgery.ConclusionImaging appears to be unreliable in differentiating benign cysts from malignant renal tumours, raising a diagnostic dilemma where surgery seems the only way to reliably establish aetiology of the mass.

A case of multilocular renal cysts

– The authors describe a case of voluminous multilocular cysts of the left kidney in a 41-year-old woman. Potter's dysplatic, Friedman's congenital, Arey's hamartomatose theories have all been put forward regarding the histopathogenesis of this disease. The lack of renal tissue in the septa, the presence of non-communicating compartments containing liquid and the normality of the surrounding parenchyma distinguish this pathology from other cystic lesions of the kidney. Although imaging techniques show the presence of renal lesions, they are not pathognomonic for multilocular renal cysts. The patient underwent left nephrectomy and the histological exam confirmed the diagnosis.

A Rare Case of Bilateral Multilocular Renal Cysts

Several names have been used to describe a rare multiloculated cystic lesion in the kidney, including benign multilocular cyst, multilocular cystic nephroma, cystic nephroma and others. The abundance of names is partially attributable to an incomplete understanding of the etiology and natural history of this condition. Most authorities believe that this lesion is part of a spectrum of renal cystic disorders with multilocular cyst and cystic Wilms tumor representing the 2 extremes. Whatever the etiology, multilocular cysts have a typical radiographic appearance, are almost uniformly unilateral and are treated with curative nephrectomy. We report a unique case of bilateral multilocular renal cysts treated with bilateral partial nephrectomy. CASE REPORT A 15-month-old Hispanic boy presented with a 3-month history of progressively enlarging bilateral flank masses, and nausea, vomiting and anorexia 1 week in duration. There was no other significant medical history. Physical examination revealed blood pressure of 100/60 mm. Hg and abdominal examination demonstrated bilateral 12 to 14 cm., nontender, nonfixed, firm flank masses. Serum electrolytes, urea nitrogen, creatinine, hemoglobin and urinalysis were normal. Abdominal ultrasound and computerized tomography showed 10 X 12 cm. cystic renal masses with multiple septa (fig. 1). A rim of normal appearing renal parenchyma (right side greater than left side) was displaced inferiorly and medially. 3-Mercaptoacetyltriglycine nuclear renal scan revealed that 80% of renal function was by the right kidney. Abdominal exploration was planned but moderate hypertension developed, which was controlled with oral calcium channel blockers. Subsequently exploration was performed through a transperitoneal midline incision. The left renal mass was approached first, revealing a firm mobile cystic renal mass contiguous with the inferior pole of normal appearing renal tissue. Because of the benign appearance of this mass and bilateral involvement, a nephron sparing procedure was performed involving partial nephrectomy with renal reconstruction. The mass was completely excised en bloc (fig. 2). However, the dilated renal pelvis was opened to extrude the inferior aspect of the mass, which had herniated into the collecting system. Frozen section was consistent with a multilocular renal cyst without evidence of malignancy. Exploration of the right side revealed similar fmdings and an identical procedure was performed. Postoperatively the patient recovered well. He is currently asymptomatic and thriving, and hypertension has completely resolved. Followup renal scan and ultrasound 6 months postoperatively demonstrated excellent function of both remaining renal units with no evidence of any recurrent cystic lesions. The final pathological diagnosis was consistent with bilateral benign multilocular renal cysts.

Prognosis of renal cell carcinoma coexisting with renal cystic diseases--results of nation-wide survey in Japan

To study the outcome of the patients with renal cell carcinoma (RCC) coexisting with renal cystic disease. The nation-wide survey conducted in 1989 enrolled 223 patients with RCC coexisting with renal cystic disease. Of those 223, we could follow up 216 patients in the second survey in 1994. Renal cystic diseases coexisting with RCC included simple renal cysts in 69 cases, acquired cystic disease of the kidney (ACDK) in 61, cystic RCC in 54, multilocular renal cysts in 19, polycystic kidney in 3, miscellaneous cysts in 9, and unspecified cyst in 1. The overall 5-year survival was 84%. The mean survival of the patients without any symptoms was significantly higher than that of those with symptoms. The survival of those with ACDK was lowest, and that will cystic RCC was highest. The survival was significantly different between the two groups, however the disease specific survival excluding the effect of dialysis was not significantly different between the two groups. Regarding TNM category, those with pT1 or pT2, comprising 87% of the subjects, carried a prognosis more favorable than those with pT3 or pT4. Among those undergoing cyst puncture (47 patients), positive cytology resulted in poorer prognosis. However, there was no such difference in the prognosis between punctured group and non-punctured group. Those with RCC coexisting with renal cystic disease carried a favorable prognosis. Cyst puncture were not concluded to exert an unfavorable effect on the prognosis at least in this study.

Patients with renal cysts associated with renal cell carcinoma and the clinical implications of cyst puncture: a study of 223 cases

Objectives. To clarify the association between renal cysts and renal cell carcinoma (RCC), we analyzed patient demographics, types of cystic disease, and modes of cyst-tumor coexistence along with the results of cyst puncture.Methods. A total of 507 hospitals provided information regarding clinical experiences with RCC and cyst puncture over a 2-year period.Results. Renal cysts were identified by preoperative imaging in 223 (4%) of 5721 patients with RCC. Histologic examination revealed cystic RCC in 56 patients (25%) and RCC associated with cystic diseases in 167 (75%). Cystic disease included simple cysts in 72 patients (32%), acquired cystic disease of the kidney (ACDK) in 62 (28%), multilocular renal cysts in 20 (9%), polycystic kidney in 3 (1%), and unspecified or miscellaneous in 10. Cyst puncture performed in 47 (21%) of 223 patients demonstrated bloody fluid in 20 cases and nonbloody fluid in 27. Cytologic analysis of cystic fluid obtained from 37 patients revealed a malignancy in 5 (14%), accounting for 25% of the bloody and 4.8% of nonbloody specimens. Cytology failed to detect RCC in ACDK and multilocular cysts but was positive in cases of cystic RCC and solitary cysts. Four of 5 cytology-positive cases comprised those of tumor in cyst and cyst within tumor.Conclusions. Simple cysts and ACDK accounted for 60% of the renal cysts associated with RCC. Cystic RCC was involved in 25% of cases. Positive cytology may be expected in select cases, including those with close cyst-tumor relationships and those involving bloody cyst fluid. However, negative cytology does not exclude RCC.

Evidence for association between renal cell carcinomas and renal cystic diseases: nationwide survey in Japan

A scanty evidence previously reported regarding renal cell carcinomas occurring in association with renal cystic diseases prompted us to conduct a nationwide survey in July 1991. A total of 507 hospitals responded to the questionnaire inquiring the clinical and pathological characteristics of renal cell carcinoma associated with renal cystic diseases over the previous 2 years. Renal cystic diseases were identified in 223 (3.9%) of 5,721 patients with renal cell carcinoma. The patients consisted of 181 men and 42 women who had a mean age of 55.2 +/- 12.5 years (SD). The renal cystic diseases comprised simple renal cysts in 72 patients (32%), acquired cystic diseases of the kidney (ACDK) in 62 (28%), cystic renal cell carcinoma in 56 (25%), multilocular renal cysts in 20 (9%), polycystic kidney in 3 (1.3%), miscellaneous cysts in 9 (4.0%), and unspecified cysts in 1 (0.4%). Simple renal cysts were more common in older patients, while ACDK and multilocular cysts were more predominant in younger patients. They included 71 dialysis patients (32%), of whom 62 (87%) had ACDK. Renal cell carcinoma occurred bilaterally in 12 patients (17%) on dialysis. Young male patients over a longer dialysis period were more susceptible to renal cell carcinoma. Low stage tumor, papillary type and granular cell subtype were more common in those on dialysis than in those without dialysis. In consideration of the Japanese general and dialysis population, we confirmed that dialysis patients with ACDK are more susceptible to renal cell carcinoma and those with polycystic kidney are less so. Renal cystic diseases may be associated with about 4% of renal carcinoma. Young male patients over a longer dialysis period who are diagnosed to have renal cysts should be regularly and closely followed by imaging study.

Usefulness of color Doppler flow imaging in differential diagnosis of multilocular cystic lesions of the kidney.

Color Doppler flow imaging was carried out in 10 multilocular cystic lesions of the kidney. These consisted of three renal cell carcinomas, three hemorrhagic renal cysts, one benign multilocular cystic nephroma, two infected renal cysts, and one benign multilocular renal cyst secondary to von Hippel-Lindau disease. In the patients with renal cell carcinoma, color signals were obtained at the septum and in the solid component within the lesions. A pulsatile wave with a large maximum flow velocity and a high PI value was obtained in two of them. In one of the patients with hemorrhagic renal cysts, color signals were obtained at the region of the septum. In the other benign lesions, however, color signals were obtained only at the peripheral margin, and the flow waveform in these cases was identical to the waveforms found in the interlobar arteries. This study suggested that color display in the lesion well reflects its vascularity in patients with multilocular cystic renal diseases and that measurement of the systolic maximum flow velocity by fast Fourier transform analysis is useful for the differential diagnosis of malignant versus benign lesions.

Adenocarcinoma renale in cisti renale multiloculare. A proposito di 2 rari casi trattati con terapia chirurgica conservativa: Adenocarcinoma in multilocular renal cyst. A report of 2 cases treated with conservative surgery

The Authors present the surgical approach and the management of two new cases of adenocarcinoma in multilocular renal cyst treated with conservative surgery. The pathological and clinical findings are presented and the difficulty in differentiating benign versus malignant lesions is discussed.

Multilocular renal cyst (cystic nephroma) with müjllerian-like stroma

Multilocular renal cyst is an uncommon lesion of controversial histogenesis. The authors report a case of renal multilocular cyst with mullerian (ovarian)-like stroma. We suggest that this finding would support a dysontogenetic origin for the lesion.

Multilocular Renal Cyst

Multilocular renal cyst is an uncommon lesion of uncertain pathogenesis seen in children and adults. We report the immunohistochemical and lectin-binding profiles of three MRC occurring in adults. All cases had strong and uniform cytoplasmic staining of lining epithelial cells for keratin and binding sites for arachis hypogaea lectin, similar to that seen for the distal convoluted tubules or collecting ducts in normal kidney. However, we found variable expression of other distal nephron markers, including epithelial membrane antigen and Ber-EP4. Furthermore, lining cells in some lesions coexpressed proximal nephron markers such as alpha-1-antitrypsin and lysozyme, as well as binding sites for lotus tetragonolobus lectin. Immunostaining for type IV (basement membrane) collagen demonstrated a continuous subepithelial basement membrane zone and basal laminae surrounding desmin-positive stromal cells. Areas of active collagen synthesis and stromal procollagen deposition were visualized within the interlocular septae using a monoclonal antibody to type I procollagen. Significant proliferative activity was not detected in the lining epithelium or stroma using the anti-proliferating cell nuclear antigen. In conclusion, MRC show aberrant tubular epithelial glycoprotein and glycoconjugate expression, low proliferative activity, and associated activation of interlocular stromal cells.

Multiloculated renal cell carcinoma

Multiloculated renal cell carcinoma and multilocular renal cyst with renal cell carcinoma are uncommon diseases. We report on 2 cases of multiloculated renal cell carcinoma. To our knowledge 16 cases of multiloculated renal cell carcinoma and multilocular renal cyst with renal cell carcinoma have been previously described in detail. The authors review the literature and discuss the aetiology and diagnosis of the disease.

Renal peripelvic lymphangiectasia: appearance at CT.

In a patient who had undergone emergency nephrectomy during exploratory surgery, a pathologic diagnosis of peripelvic lymphangiectasia was made. Subsequent computed tomographic examination of the remaining kidney showed large multilocular renal sinus cysts, renal capsular cysts, and regions of fluid attenuation surrounding the mesenteric vessels, findings consistent with peripelvic lymphangiectasia. A brief discussion of cystic disease of the renal sinus is presented.

Multilocular cysts of kidney

Multilocular renal cyst is a distinct renal tumor whose gross external appearance and absence of normal renal tissue within the septa of loculi distinguish it clearly from other renal cystic lesions. Interlocular septa may contain either (1) fibrous tissue alone or (2) embryonic tissue separating adjacent loculi. Of 29 patients with multilocular renal cysts, 24 underwent a renal-sparing procedure, and only 5 had radical nephrectomy. None of the histologic specimens showed evidence of immature renal tissue or neoplasia. Patients were followed from three months to eight years (mean, 39 months), and no evidence of local recurrence or metastatic disease was found. Because it is difficult to distinguish multilocular renal cyst from cystic Wilms tumor and multicystic clear cell carcinoma on the basis of imaging studies alone, surgical intervention is the only effective method to differentiate multilocular renal cyst from a malignant lesion of the kidney.

Renal Cell Carcinoma in a Multilocular Renal Cyst: A Case Report of a 27-Year-Old Female and Review of the Literature

A case of renal cell carcinoma in a multilocular renal cyst is reported. Excretory urography showed a mass, and ultrasound revealed multiple renal cysts in the middle part of the left kidney. This finding could also be visualized by computer tomography, a solid structure could not be detected. During operation a 6-cm multiloculated cyst was enucleated from the left kidney. A frozen section of the cystic lesion did not indicate a malignancy; however, further histopathological examination revealed a renal cell carcinoma, especially in the septal parts of the tumor.

Multilocular renal cyst associated with transposition of the inferior vena cava and malrotation of the bowel

A case is presented of an adult male patient with a heavily calcified multilocular renal cyst (Perlmann's tumor), transposition of the inferior vena cava and reversed rotation (malrotation) of the bowel. Because of the synchronous embryological development of the forementioned structures, a possible congenital etiology of the multilocular renal cyst is suggested.

Hyperdiploidy including trisomy 8 in a cystic partially differentiated nephroblastoma

Cystic partially differentiated nephroblastoma (CPDN), a rare, cystic, renal lesion of childhood, has not been previously karyotyped. It is distinguished histologically from multilocular renal cyst by the presence of blastemal cells, and from Wilms' tumor by lack of expansile, solid growth and by indolent clinical behavior. In the present case, ten of 20 analyzed cells from a 3-week culture obtained from the tumor had a clonal, hyperdiploid karyotype. The modal chromosome number was 51, with chromosomes 8, 12, 17, 19, and 20 usually being present in three copies. Trisomy 8 was present in every hyperdiploid cell examined. A normal 46,XY constitutional karyotype was also observed. In degree and significance, the hyperdiploidy of CPDN is thus distinct from that reported in the prognostically unfavorable, anaplastic Wilms' tumor, where the DNA index is typically near-tetraploid. Trisomy 8, as a constitutional mosaicism, has been previously reported in children with bilateral CPDN and/or undifferentiated sarcomas, although none of their tumors were karyotyped. The present findings support a neoplastic nature for CPDN, while emphasizing its pathogenetic distinctiveness from Wilms' tumor, and provide further evidence for significance of trisomy 8 in the pathobiology of this tumor.

Multilocular Renal Cyst: Scanning and Transmission Electron Microscopic Observations

A multilocular renal cyst in a boy aged one year and four months is presented, with particular attention being paid to the nature of the epithelial lining cells. Light and transmission electron microscopy showed the cyst to be lined by a single layer of flattened or cuboidal epithelial cells of relatively uniform morphology. Neither embryonic elements nor nephroblastomatous foci were noted in the intervening stroma. The scanning electron microscopy showed hitherto undescribed surface morphological features of the epithelial lining cells: They were characterized by the presence of one or, occasionally two centrally positioned long cilia and by variably oriented microvilli. The observations presented here suggested that the lining cells of the cyst most closely resembled the principal cells of the collecting ducts, especially those located in the inner medulla of the kidney. An unexpected finding was the additional occurrence of a giant bullous lesion in the right lung of this patient.