CYSTIC TUMORS OF THE KIDNEY
Authors:
Tomáš Pitra 1; Kristýna Pivovarčíková 2; Ivan Trávníček 1; Kristýna Procházková 1; Ondřej Hes 2; Hynek Mírka 3; Radek Tupý 3; Milan Hora 1
Authors‘ workplace:
Urologická klinika LF UK a FN Plzeň
1; Šiklův ústav patologie LF UK a FN Plzeň
2; Klinika zobrazovacích metod LF UK a FN Plzeň
3
Published in:
Ces Urol 2016; 20(3): 204-213
Category:
Review article
Overview
Major statement:
Review dealing with clinical manifestation, diagnostic process and management of cystic tumors of the kidney. Review of literature.
Introduction:
A relatively small part of tumors of kidney is manifested as cystic tumors – 8% – based on our cohort of patients. Both benign and malignant lesions are included in this group. Such lesions have generally better prognosis than socalled solid tumors. Overview of cystic renal lesions: Typical representatives of tumors included in the cystic group are – multilocular cystic renal neoplasm of low malignant potential, mixed epithelial and stromal tumor of kidney (MESTK), and tubulocystic renal cell carcinoma. Secondary cystic changes can be seen mostly in clear cell renal cell carcinoma and papillary renal cell carcinoma type 1.
Imaging:
The classification and following management of these lesions is based on Bosniak classification of cystic renal masses. Magnetic resonance imaging (MRI) and contrast enhanced ultrasound (CEUS) are other modalities, which can be used to refine the diagnosis/differential diagnosis. Results of both these methods can be classified using Bosniak classification system.
Management:
Management of cystic lesion depends on classification. Bosniak I and II type cysts are lesions, that are considered to be benign and no follow-up is needed. Bosniak III and IV type cysts are the surgical lesions. In the Bosniak III category the risk of aggressive tumor is minimal, so nephron sparing surgery is recommended. Bosniak IIF is frequently discussed. There are no straightforward guidelines with regard to the appropriate management of this group. Follow-up is the most frequent recommendation.
KEY WORDS:
Bosniak classification, cystic tumors of kidney, diagnostic, management.
Sources
1. Park HS, Lee K, Moon KC. Determination of the cutoff value of the proportion of cystic change for prognostic stratification of clear cell renal cell carcinoma. J Urol. 2011; 186(2): 423–429.
2. Eble JN, Guido S, Epstein JI, et al. World Health Organization Classification of Tumours. Pathology and Geneticsof Tumours of the Urinary System and Male Genital Organs. Lyon: IARCPress; 2004.
3. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016.
4. Gong K, Zhang N, He Z, et al. Multilocular cystic renal cell carcinoma: an experience of clinical management for 31 cases. J Cancer Res Clin Oncol. 2008; 134(4): 433–437.
5. Kuroda N, Ohe C, Mikami S, et al. Multilocular cystic renal cell carcinoma with focus on clinical and pathobiological aspects. Histol Histopathol. 2012; 27(8): 969–974.
6. You D, Shim M, Jeong IG, et al. Multilocular cystic renal cell carcinoma: clinicopathological features and preoperative prediction using multiphase computed tomography. BJU Int. 2011; 108(9): 1444–1449.
7. Amin MB, Tamboli P, Javidan J, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol. 2002; 26(3): 281–291.
8. Delahunt B, Eble JN. Papillary renal cell carcinoma: a clinicopathologic and immunohistochemical study of 105 tumors. Mod Pathol. 1997; 10(6): 537–544.
9. Weibl P, Hora M, Kollarik B, Shariat SF, Klatte T. Management, pathology and outcomes of Bosniak category IIF and III cystic renal lesions. World J Urol. 2015; 33(3): 295–300.
10. Kosaka T, Mikami S, Miyajima A, et al. Papillary renal cell carcinoma: clinicopathological characteristics in 40 patients. Clin Exp Nephrol. 2008; 12(3): 195–199.
11. Kuroda N, Toi M, Hiroi M, Enzan H. Review of papillary renal cell carcinoma with focus on clinical and pathobiological aspects. Histol Histopathol. 2003; 18(2): 487–494.
12. Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015; 67(5): 913–924.
13. Alomari AK, Nettey OS, Singh D, Kluger H, Adeniran AJ. Clinicopathological and immunohistochemical characteristics of papillary renal cell carcinoma with emphasis on subtyping. Hum Pathol. 2015;
46(10): 1418–1426.
14. Hora M, Urge T, Eret V, et al. Tubulocystic renal carcinoma: a clinical perspective. World J Urol. 2011; 29(3): 349–354.
15. Alexiev BA, Drachenberg CB. Tubulocystic carcinoma of the kidney: a histologic, immunohistochemical, and ultrastructural study. Virchows Arch. 2013; 462(5): 575–581.
16. Amin MB, MacLennan GT, Gupta R, et al. Tubulocystic carcinoma of the kidney: clinicopathologic analysis of 31 cases of a distinctive rare subtype of renal cell carcinoma. Am J Surg Pathol. 2009; 33(3): 384–392.
17. Azoulay S, Vieillefond A, Paraf F, et al. Tubulocystic carcinoma of the kidney: a new entity among renal tumors. Virchows Arch. 2007; 451(5): 905–909.
18. Montironi R, Mazzucchelli R, Lopez-Beltran A, et al. Cystic nephroma and mixed epithelial and stromal tumour of the kidney: opposite ends of the spectrum of the same entity? Eur Urol. 2008; 54(6): 1237–1246.
19. Lane BR, Campbell SC, Remer EM, et al. Adult cystic nephroma and mixed epithelial and stromal tumor of the kidney: clinical, radiographic, and pathologic characteristics. Urology. 2008; 71(6): 1142–1148.
20. Michal M, Syrucek M. Benign mixed epithelial and stromal tumor of the kidney. Pathol Res Pract. 1998; 194(6): 445–448.
21. Michal M, Hes O, Bisceglia M, et al. Mixed epithelial and stromal tumors of the kidney. A report of 22 cases. Virchows Arch. 2004; 445(4): 359–367.
22. Sahni VA, Mortele KJ, Glickman J, Silverman SG. Mixed epithelial and stromal tumour of the kidney: imaging features. BJU Int. 2010; 105(7): 932–939.
23. Hora M, Michal M, Hes O. Letter to the editor: Rodolfo Montironi, Roberta Mazzuccelli, Antonio Lopez‑Beltran, et al. Cystic nephroma and mixed epithelial and stromal tumour of the kidney: opposite ends of
the spectrum of the same entity? Eur Urol. 2009; 56(1): e3.
24. Vanecek T, Pivovarcikova K, Pitra T, et al. Mixed Epithelial and Stromal Tumor of the Kidney: Mutation Analysis of the DICER 1 Gene in 29 Cases. Appl Immunohistochem Mol Morphol. 2015.
25. Graumann O, Osther SS, Karstoft J, Hørlyck A, Osther PJ. Bosniak classification system: a prospective comparison of CT, contrast-enhanced US, and MR for categorizing complex renal cystic masses. Acta
Radiol. 2015.
26. Ascenti G, Mazziotti S, Zimbaro G, et al. Complex cystic renal masses: characterization with contrastenhanced US. Radiology. 2007; 243(1): 158–165.
27. Foukal J. Srovnání kontrastní ultrasonografie a CT v klasifikaci cystických lézí ledvin. In: Mechl M, editor. Česká radiologie: Grada; 2014. p. s. 30–39.
28. Bosniak MA. The current radiological approach to renal cysts. Radiology. 1986; 158(1): 1–10.
29. Han HH, Choi KH, Oh YT, Yang SC, Han WK. Differential diagnosis of complex renal cysts based on lesion size along with the Bosniak renal cyst classification. Yonsei Med J. 2012; 53(4): 729–733.
30. Israel GM, Bosniak MA. An update of the Bosniak renal cyst classification system. Urology. 2005; 66(3): 484–488.
31. Warren KS, McFarlane J. The Bosniak classification of renal cystic masses. BJU Int. 2005; 95(7): 939–942.
32. Israel GM, Bosniak MA. MR imaging of cystic renal masses. Magn Reson Imaging Clin N Am. 2004; 12(3): 403–412, v.
33. Wood CG, Stromberg LJ, Harmath CB, et al. CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics. 2015; 35(1): 125–141.
34. Israel GM, Hindman N, Bosniak MA. Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology. 2004; 231(2): 365–371.
35. Ellimoottil C, Greco KA, Hart S, et al. New modalities for evaluation and surveillance of complex renal cysts. J Urol. 2014; 192(6): 1604–1611.
36. Marconi L, Dabestani S, Lam TB, et al. Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy. Eur Urol. 2016; 69(4): 660–673.
37. Wein AJ, Kavoussi LR, et al. Campbell-Walsh Urology – 10. ed., Philadelphia: Saunders, Elsevier; 2012; 1492–1494.
38. Weibl P, Klatte T, Waldert M, Remzi M. Complex renal cystic masses: current standards and controversies. Int Urol Nephrol. 2012; 44(1): 13–18.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2016 Issue 3
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