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Pediatric cystic nephroma is a rare, clinically benign, renal tumor. Pediatric renal cystic lesions are complex. Imaging findings and tumor appearance are often nonspecific, and careful pathological examination is necessary. We discuss diagnosis of pediatric cystic nephroma and how to differentiate it from multicystic dysplastic kidney and cystic partially differentiated nephroblastoma.
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Objective: To explore the clinicopathological features and the diagnostic value of the CT scan in multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and cystic nephroma (CN). Methods: The clinical data of 12 patients with CN and 20 patients with MCRNLMP, confirmed by pathology at the Renmin Hospital of Wuhan University and Jingzhou Central Hospital from Janu-ary 2000 to March 2019, were retrospectively analyzed. The receiver operating characteristic (ROC) curves were used to analyze the feature of contrast-enhanced CT images of the tumors, and the immunophenotypes of the tumors were observed by immunohisto-chemistry. Results: There were statistically significant differences between MCRNLMP and CN in terms of thickness of the cyst wall and partition, number of soft-tissue enhancing masses, peak intensity of enhancement, and the Bosniak classification (P<0.05). Based on ROC curve analyses, when the thickness of the capsule wall and partition was greater than 2.25mm, the number of enhanced high-density lesions was greater than 1, and the peaking intensity of fortification was above the moderate level in the diagnosis of CRNLMP. The areas under the curve of the three indexes were 0.879, 0.800 and 0.838, which can be used as the best diagnostic criterion for MCRNLMP. Immunophenotyping revealed that MCRNLMP characteristically expressed the renal cell carcinoma (RCC) marker, and CN characteristically expressed the estrogen receptor(ER) and progesterone receptor(PR). Conclusions: The cyst wall and septal thickness, number of soft-tissue enhancing masses, and peak intensity of enhancement show a higher diagnostic value in differentiating MCRN-LMP and CN. The precise diagnosis relies on the pathological and immunohistochemical examination.
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Objective To discuss the diagnostic performance of MSCT in cystic nephroma(CN).Methods The MSCT findings of CN in 7 patients proved by operation and pathology were retrospectively reviewed.Results All of 7 cases were isolated cystic lesion, including 5 males and 2 females.MSCT scanning showed cystic tumor in the renal parenchyma with well-defined boundary.All cases showed regular cystic wall and septa with no attached cystic wall nodule.The cystic wall and septa appeared homogeneous enhancement on contrast-enhanced CT,while the cystic space showed inhomogeneous density and lack of enhancement.Conclusion The MSCT findings of CN may benefit the definite diagnosis.
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Objective Cystic nephroma ( CN ) is an unusual benign neoplasm with high misdiagnosis rate , and at present there is no general method on its treatment .This study aimed to analyze the diagnosis and treatment of CN based on clinical data of CN patients. Methods We retrospectively analyzed the clinical data on 25 patients (including 2 cases of male pediatric patients , aged 14 and 16 years old, and the remaining 23 cases were adults, 11 males and 12 females, aged 14-69[45.1 ±19.6]years) treated in our department of the First Hospital of Shijiazhuang from January 2003 to July 2015 .All patients underwent ultrasound , CT and MRI examination , as well as surgical resection . Results Among these 25 CN patients , there were 15 cases of partial nephrectomy , 5 ca-ses of nephrectomy , 2 cases of retroperitoneal laparoscopic cyst unroofing , 1 case of laparoscopic enucleation of the tumors with nephron-sparing surgery , 1 case of laparoscopic radical nephroureterectomy , and 1 case of retroperitoneal laparoscopic radical nephrectomy .All the patients were successfully followed up for 6 months to 132 months, 1 patient recurred 6 months after retroperitoneal laparoscopic cyst unroo-fing and underwent open partial nephrectomy .No recurrence and me-tastasis were found in the remaining patients . Conclusion Imaging examination is an important measurement for CN , and intraoperative frozen pathology contributes to pathological diagnosis .Since most CN cases are benign , CN patients with no symptom or small cysts can take follow up survey .The principle of the operation is complete resection of the tumor , and nephron-sparing surgery is the first choice . In addition , regular follow-up is necessary in case of recurrence and malignant potential .
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Cystic nephroma (CN) is a benign cystic neoplasm composed of mixed epithelial and stromal elements. Less than 200 cases have been reported. We had a patient, a 41-year-old woman, who had a huge typical CN. The patient was admitted for a right renal mass that was found incidentally. On laparaoscopic right nephrectomy, there was an encapsulated 7 cm multilocular cystic mass at the upper pole. Microscopically, the cystic wall was lined by a single layer of low cuboidal or hobnail epithelium without a solid area. The thin septa were composed of bland, ovarian type spindle cells. The main differential diagnoses were mixed epithelial and stromal tumor (MEST), low grade multilocular renal cell carcinoma, and tubulocystic carcinoma. The results of immunohistochemical staining were cytokeratin 7/19(+/+) and CD10(-) in lining epithelium, estrogen receptor/progesterone receptor(+/+) in stromal cells. After surgery, she was free of recurrence for 10 months. We report this rare case and compare it with other cystic renal tumors, especially MEST.
Subject(s)
Adult , Female , Humans , Carcinoma, Renal Cell , Diagnosis, Differential , Epithelium , Estrogens , Keratins , Kidney , Nephrectomy , Receptors, Estrogen , Recurrence , Stromal CellsABSTRACT
Objective To investigate the features of the mixed epithelial and stromal tumor of kidney (MESTK) and cystic nephroma (CN) on multi-detector CT (MDCT), in order to improve the accuracy of preoperative diagnosis and differential diagnosis. Methods Based on blind-retrospective review, CT features of 6 MESTK patients and 6 CN patients were reviewed retrospectively, and compared with pathological results postoperatively. Results All the lesions were single regular multi-cystic masses. Five patients with MESTK were diagnosed as Bosniak Ⅲ and 1 as Bosniak Ⅳ. In contrast, 6 of CN were all diagnosed as Bosniak Ⅱ. Six MESTK lesions were all consisted of irregular mixture of solid and cystic components, and the average thickness of septa was 0.93 cm. Six CN lesions were entirely cystic masses without solid components, and the average thickness of septa was 0.23 cm. After contrast enhancement, the solid components of MESTK and the cystic wall of CN presented mild-to-moderate delayed enhancement. Conclusion Some signs on multi-detector CT can help to differentiate MESTK and CN, especially the presence of solid components of the tumor.
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Multilocular cystic nephroma is a rare disease, noninherited benign renal neoplasm occurring in both children and adults. It is necessary to make a differential diagnosis from all renal diseases with a cystic component, such as Wilms tumor, armatoma or polycystic dysplastic kidney in childhood. There are about only 200 case reports in the world since Walter Edmunds had described it first. We report a case of multilocular cystic nephroma presented with painless abdominal mass, treated with nephrectomy and confirmed with pathology.
Subject(s)
Adult , Child , Humans , Diagnosis, Differential , Kidney , Kidney Neoplasms , Nephrectomy , Pathology , Rare Diseases , Wilms TumorABSTRACT
We present a case of 15 months old male with Multilocular cystic nephroma (MLCN) which contains fibroblast, smooth muscles, skeletal muscles and well differentiated tubular structure in the septa without evidence of blastemal or embryonal elements. There is no evidence of metastasis and local recurrence after post-op 2 years.
Subject(s)
Child , Humans , Infant , Male , Fibroblasts , Muscle, Skeletal , Muscle, Smooth , Neoplasm Metastasis , RecurrenceABSTRACT
Multilocular cystic nephroma of the kidney is an infrequent lesion and has been reported in the literature under several names. These various denominations reflect the controversy about its nature. Some authors include the lesion among renal dysplasia, while others consider it to be a benign neoplasm that might be related to nephrtblastoms(Wilms` tumor). We present a case of 52 year old male with multilocular cystic nephroma of the left kidney which was composed of highly cellular spindle shaped stromal cells and locally recurred as sarcoma after nephrectomy.
Subject(s)
Humans , Male , Middle Aged , Kidney , Nephrectomy , Sarcoma , Stromal CellsABSTRACT
Multilocular cystic renal cell carcinoma appears to be a distinct and rare subtype of renal cell carcinoma with characteristic gross and microscopic features. Multilocular cystic renal cell carcinoma should be separated from multilocular cyst, multilocular cystic nephroma, and renal cell carcinoma with cystic degeneration. We present a case of multilocular cystic renal cell carcinoma. A 61-year-old man presented with right flank pain for 4 years. The computerized tomography revealed multilocular cystic mass in the upper pole of right kidney. The cystic mass measured 4.5x4 cm. The cyst was multilocular and locules not communicated with each other. The solid area was not present. Microscopically, the locules were lined by flat or cuboidal neoplastic clear cells. The clear cells were focally aggregated in the septa. The nephron was not present in the septa.