Diagnosis and treatment of cystic renal cell carcinoma

Abstract

Background: To summarize the diagnosis and treatment of cystic renal cell carcinoma (CRCC).

Methods: A retrospective study was conducted on 13 patients with CRCC at our center from August 2004 to April 2012. The pathologic features, clinical manifestation, imaging characteristics, treatment, and prognosis of CRCC were summarized according to available literature.

Results: Of the 13 patients, 11 were diagnosed with CRCC by preoperative B ultrasonography and computed tomography (CT) scan. The remaining two cases were initially misdiagnosed with simple renal cysts. Open radical nephrectomy was performed on two of the 13 cases, laparoscopic radical nephrectomy on seven cases, and open partial nephrectomy on four cases. All diagnoses of CRCC were confirmed by pathological examination. After the operation, all patients had an uneventful recovery. During the follow-up (range, 6-60 months), the serum creatinine concentrations and GFR of the partially removed kidneys remained stable within the normal range. No tumor recurrence or metastasis occurred.

Conclusions: By combining imaging examinations (B ultrasonography and CT scan) with intraoperative pathological examination, most cases of CRCC can be diagnosed and treated promptly and accurately. Nephrectomy is the first-line therapy. Nephron-sparing surgery should be preferred for CRCC. After a successful operation, the prognosis of CRCC is good.

Figure 1

A typical B ultasonographic image of CRCC. The uneven cystic walls, hyperechoicsepa, and nodules were visible.

Figure 2

A typical CT scan image of a left kidney with CRCC. (A)The CT scan showed the thick and irregular capsule walls surrounding several cysts with hyperdense septa and nodules. (B)The enhanced CT scan image showed the intense enhancements and calcification of capsule walls, septa, and nodules. The debris, floc, and blood clots were also visible in the hydatid fluid.