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. 2022 Feb 6;14(3):831.
doi: 10.3390/cancers14030831.

A Comprehensive Commentary on the Multilocular Cystic Renal Neoplasm of Low Malignant Potential: A Urologist's Perspective

Tomas Pitra  1 , Kristyna Pivovarcikova  2 , Reza Alaghehbandan  3 , Adriena Bartos Vesela  1 , Radek Tupy  4 , Milan Hora  1 , Ondrej Hes  2
Affiliations

A Comprehensive Commentary on the Multilocular Cystic Renal Neoplasm of Low Malignant Potential: A Urologist's Perspective

Tomas Pitra et al. Cancers (Basel). .

Abstract

Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a cystic renal tumor with indolent clinical behavior. In most of cases, it is an incidental finding during the examination of other health issues. The true incidence rate is estimated to be between 1.5% and 4% of all RCCs. These lesions are classified according to the Bosniak classification as Bosniak category III. There is a wide spectrum of diagnostic tools that can be utilized in the identification of this tumor, such as computed tomography (CT), magnetic resonance (MRI) or contrast-enhanced ultrasonography (CEUS). Management choices of these lesions range from conservative approaches, such as clinical follow-up, to surgery. Minimally invasive techniques (i.e., robotic surgery and laparoscopy) are preferred, with an emphasis on nephron sparing surgery, if clinically feasible.

Keywords: cystic tumor; imaging; kidney; magnetic resonance; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Imaging methods: comparison of CT imaging (A,C) and MRI (B,D) of the same lesion. There is a clearly visible benefit of MRI in imaging of the inner architecture with more precise imaging of the septa. (E,F) Intraoperative ultrasound image of MCRNLMP.
Figure 2
Figure 2
Macroscopic appearance of the MCRNLMP specimen from nephron sparing surgery. There is a multicystic lesion with a thin septa and variable sized cystic spaces without solid expansion.
Figure 3
Figure 3
Macroscopic appearance of an MCRNLMP specimen from nephron sparing surgery. The dominant cystic space contains smaller cystic expansion. The absence of solid mass is crucial for the diagnosis of MCRNLMP, and must be proved by microscopic examination of the specimen.
Figure 4
Figure 4
Histological appearance of MCRNLMP: (A,B) The lesion is characterized by the formation of cystic spaces—various sized cysts are separated by thin, fibrous septa (magnification 10×, resp. 60×). (C) The epithelial lining is composed by neoplastic cells with clear cytoplasm arranged in a single layer (magnification 160×). (D) The epithelial lining is positive in PAX8 (magnification 10×). (E) Equally, carbonic anhydrase IX (CAIX) shows positivity in neoplastic cells (magnification 10×). (F) Strong immunoreactivity was proved in CK7 (magnification 10×).
See this image and copyright information in PMC

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