Cystic renal cell carcinoma

doi:10.1016/0090-4295(86)90109-3

Urology

Volume 28, Issue 2, August 1986, Pages 145-153

https://doi.org/10.1016/0090-4295(86)90109-3 Get rights and content

Abstract

Cystic renal cell carcinoma includes any malignant neoplasm of renal tubular epithelium which presents as a fluid filled mass. Approximately 15 per cent of cases of renal cell carcinoma will be cystic on radiologic and pathologic examination. The clinical features of cystic renal cell carcinoma are similar to those which are solid. The radiographic and pathologic findings of cystic renal cell carcinoma are often more confusing and less specific than the findings of renal cell carcinoma which are predominantly solid. There are four basic pathologic mechanisms resulting in cystic renal cell carcinoma: (1) intrinsic multiloculated growth; (2) intrinsic unilocular growth (cystadenocarcinoma); (3) cystic necrosis; and (4) origin from the epithelial lining of a preexisting simple cyst. There are three basic radiologic patterns of cystic renal cell carcinoma: unilocular cystic mass, multiloculated cystic mass, and discrete mural nodule in a cystic mass. Cystic renal cell carcinoma is often extremely difficult to differentiate from non-neoplastic, benign neo-plastic, and other malignant neoplastic masses utilizing radiologic studies alone. This review presents the clinical, pathologic, and radiographic features of cystic renal cell carcinoma and discusses its radiologic differential diagnosis.

References (37)

D. Khorsand
Carcinoma within solitary renal cysts
J Urol
(1965)
S. Weitzner
Clear cell carcinoma of the free wall of a simple renal cyst
J Urol
(1971)
K.R. Varma et al.
Papillary carcinoma in wall of simple renal cyst
Urology
(1974)
G. Sufrin et al.
Hypernephroma arising in wall of simple cyst
Urology
(1975)
S.S. Ambrose
Unsuspected renal tumors associated with renal cysts
J Urol
(1977)
F.F. Marshall
The role of selective exploration in ambiguous renal cystic lesions
Urol Clin North Am
(1980)
J.F. Norfray et al.
Carcinoma in a renal cyst: computed tomography diagnosis
J Urol
(1981)
R.H. Lewis et al.
Multilocular cystic renal adenocarcinoma arising in a solitary kidney
J Urol
(1982)
J.L. Emmett et al.
Co-existence of renal cyst and tumour: incidence in 1,007 cases
Br J Urol
(1963)
J.K. Silverman et al.
Tumor in the wall of a simple renal cyst
Radiology
(1969)

M. Gross et al.

The simultaneous occurrence of renal carcinoma and cyst: problems in management

South Med J

(1971)

E.K. Lang

Coexistence of cyst and tumor in the same kidney

Radiology

(1971)

Case records of the Massachusetts General Hospital

N Engl J Med

(1975)

J. Burstein et al.

Malignant hemorrhagic renal cyst with occult neoplasm

Radiology

(1977)

J.B. Murphy et al.

Renal cyst versus tumor: a continuing dilemma

J Urol

(1982)

W.S. Kim

Computed tomography in calcified renal masses

J Comput Assist Tomogr

(1981)

M.A.M. Feldberg et al.

Multilocular cystic renal cell carcinoma

AJR

(1982)

E.S. Amis

Renal cysts: curious and caveats

Urol Radiol

(1982)

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Multimodality Assessment of Cystic Renal Masses
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It cannot be distinguished from cystic RCC on imaging, and is likely to be classified as Bosniak III or IV due to thickened septations, enhancing nodules and curvilinear calcification.31,32 Cystic clear cell RCC accounts for 4%-15% of all RCC.33 Pathologically, it represents either a primary cystic tumour, or a secondary tumour developing within a pre-existing cyst.
Renal cysts are a common imaging finding, often incidental. Ultrasound, CT and MRI are the main modalities responsible for renal cyst detection and characterization. These modalities often play a complementary role in modern radiological practice, each of them with strengths and limitations. In view of a recently proposed ‘multimodality’ update to the historical Bosniak classification, this article provides a general overview of the current imaging approach to renal cysts, and outlines some of the diverse pathologic entities responsible for renal cyst formation.
Long-Term Outcomes of Patients With Low Grade Cystic Renal Epithelial Neoplasms
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To report on the long-term oncologic outcomes of 3 subtypes of low grade cystic renal epithelial neoplasms—multilocular cystic neoplasm of low malignant potential (MCLMP), cystic clear cell RCC (ccRCC), and cystic clear cell papillary RCC (ccpRCC), following 2016 reorganization by the World Health Organization.
A total of 3865 patients underwent radical or partial nephrectomy for unilateral, sporadic ccRCC between 1970 and 2010, of which 145 had previously been classified as cystic ccRCC. One genitourinary pathologist, blinded to outcome, rereviewed and reclassified the specimens by 2016 WHO criteria. Oncologic outcomes were estimated using the Kaplan-Meier method.
Of 145 specimens, 18 (12%) were classified as MCLMP, 95 (66%) cystic ccRCC, and 32 (22%) cystic ccpRCC. Those with MCLMP were more likely female (61% vs 29% vs 31%, P = .03) with larger tumors (median 4.6 cm vs 3.0 cm vs 2.3 cm, P = .02) compared to those with cystic ccRCC and cystic ccpRCC, respectively. Only 2% of cystic ccRCC had tumor necrosis or grade 3 nucleoli present. Median follow-up for survivors was 10.3 years (interquartile range 7.4-14.9). Overall, 1 MCLMP, 5 cystic ccRCC, and 4 ccpRCC recurred during follow-up. Ten- and 20-year cancer-specific survival was 100% across all subtypes.
In a large cohort of patients previously classified as cystic ccRCC with pathologic rereview and long-term follow-up, we noted that MCLMP is the least common subtype of low grade cystic renal epithelial neoplasms. Regardless, all subtypes are associated with an excellent long-term prognosis following surgical resection.
Ultrasound of Renal Masses
2019, Radiologic Clinics of North America
Citation Excerpt :
Urothelial carcinoma is another possible etiology for a solid mass found associated with the kidney. These involve older patients, are more common in men with a 2:1 ratio,8 and many may be secondary to industrial exposures. Risk factors include smoking, dye exposure, cyclophosphamide, and other factors.19
Classification and Diagnosis of Cystic Renal Tumors: Role of MR Imaging Versus Contrast-Enhanced Ultrasound
2019, Magnetic Resonance Imaging Clinics of North America
Imaging of Cystic Renal Masses
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Cystic Renal Cell Carcinoma: A Report on Outcomes of Surgery and Active Surveillance in Patients Retrospectively Identified on Pretreatment Imaging
2018, Journal of Urology
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.

View all citing articles on Scopus

^☆: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the view of the Departments of the Navy or Army or the Department of Defense.

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UropathologyCystic renal cell carcinoma☆

Abstract

J Urol

J Urol

Urology

Urology

J Urol

Urol Clin North Am

J Urol

J Urol

Co-existence of renal cyst and tumour: incidence in 1,007 cases

Br J Urol

Tumor in the wall of a simple renal cyst

Radiology

The simultaneous occurrence of renal carcinoma and cyst: problems in management

South Med J

Coexistence of cyst and tumor in the same kidney

Radiology

Case records of the Massachusetts General Hospital

N Engl J Med

Malignant hemorrhagic renal cyst with occult neoplasm

Radiology

Renal cyst versus tumor: a continuing dilemma

J Urol

Computed tomography in calcified renal masses

J Comput Assist Tomogr

Multilocular cystic renal cell carcinoma

AJR

Renal cysts: curious and caveats

Urol Radiol

Uropathology
Cystic renal cell carcinoma☆