Cystic Renal Cell Carcinoma

A Report of 67 Cases Including 4 Cases With Concurrent Renal Cell Carcinoma

Shanwen Chen; Baiye Jin; Liqi Xu; Guanghou Fu; Hongzhou Meng; Ben Liu; Jun Li; Dan Xia

Disclosures

BMC Urol. 2014;14(87) 

In This Article

Results

We identified 67 cases of CRCC, which represented 2.5% of the 2679 cases of RCC resected at our institution between January 2005 and April 2013; 217 out of all 2679 RCC patients had concurrent cystic renal lesions, and 4 out of the 67 CRCC patients had other concurrent RCCs (Table 1 and Table 2). For the 67 patients diagnosed with CRCC on final pathology, the average age at diagnosis was 56.0 years, with a range of 24–83 years; the average age was 58.2 years (n =46) for men and 54.7 years for women. The tumor was incidentally found during evaluation for an unrelated condition in 47 patients (70%), whereas a renal tumor was suspected in 20 (30%). Left renal cystic masses were identified in 32 patients; the remaining 35 patients had right renal cystic masses. The masses were located in the upper pole in 24 patients, the lower pole in 28, and other locations in the remaining 15. Renal ultrasound scans were available in all 67 cases (Figure 1A, B) and demonstrated a complex cystic mass in 49 cases. Renal CT scans were performed in 62 patients (Figure 1C), and a possible CRCC was reported in 48. Additional investigation included MRI in 21 patients (Figure 1D); an enhancing, cystic renal lesion suggestive of malignancy was identified in 18.

Figure 1.

Ultrasound, computed tomography, and magnetic resonance images. A) Ultrasound: Upper pole complex cystic renal mass (patient 2). B) Ultrasound: Lower pole renal solid mass (patient 2). C) Computed tomography: Lower pole renal mass with a concurrent cyst in the upper pole (patient 2). D) T1-weighted magnetic resonance imaging: Complex cystic mass with thick and irregular enhancing cyst walls in the middle part of the kidney.

The patients underwent the following surgical procedures: open radical nephrectomy (n =19), open partial nephrectomy (n =12), laparoscopic radical nephrectomy (n =9), laparoscopic partial nephrectomy (n =20), and a second anesthesia for radical nephrectomy (n =7, including 3 patients with an intraoperative frozen section diagnosis of a renal cyst and 4 patients without intraoperative frozen section analysis; the final pathological result was CRCC for all of these cases). Prior to 2010, 3 of 14 patients underwent partial nephrectomy. After 2010, 29 of 53 cases underwent partial nephrectomy. Fifty-three cases (79%) were nuclear grade I, 12 cases (18%) were nuclear grade I-II, and 2 (3%) were nuclear grade II (Figure 2). Among the 67 patients, 25 (37%) had stage T1a disease, 35 (52%) had stage T1b disease, and 7 (10%) had stage T2a disease.

Figure 2.

Pathological images from patient 2. A) Cystic renal cell carcinoma. Cysts are lined by clear cells with uniform nuclei. Clusters of clear cells are present in the septal walls. B) Renal clear cell carcinoma. The tumor consists of sheet-like, solid clear cells. H&E × 100.

All patients had uneventful surgical recoveries. Forty-six patients were followed for a mean time of 42 months (range: 6–84 months); among these, 7 patients (who were initially misdiagnosed as having benign tumors on preoperative or intraoperative pathology but confirmed as having malignant tumors on postoperative pathology) were followed for 56 months (range: 35–77 months). Their overall outcomes were excellent: there was no evidence of neoplastic recurrence or metastasis. Four cases died of non-neoplastic diseases.

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