Renal Cell Carcinoma Grossly Presenting as Cystic Lesions: A Series of Four Cases

Abstract

Kidney cancer currently ranks as the seventh most common cancer in men and the tenth most common in women. Clear-Cell Renal Cell Carcinoma (CCRCC) represents the most common malignancy of the kidney, accounting for 80% of renal carcinomas. Most CCRCC develops in patients aged over 60 years, and the incidence is slightly higher in men than in women. Partial or total nephrectomy cures the majority of patients with CCRCC. In the present discussion, the authors present cases of 4 males with RCC radiographically identified as Space Occupying Lesions (SOL) to warn clinicians that these seemingly solid lesions have a cystic component as well and may harbour underlying malignancy. Grossly, upon cutting the kidney, all four cases showed solid and cystic components, two of which were multiloculated. Histopathological Examination (HPE) revealed three cases of CCRCC and one case of cystic CCRCC. It is difficult to determine preoperatively whether a cyst is malignant based solely on imaging examinations. Regarding disease prognosis, RCC with predominantly cystic components is considered less aggressive than solid RCC. Cystic RCC (CRCC) carries an excellent prognosis following surgical treatment. Partial nephrectomy should be regarded as the preferred surgical technique in the management of CRCC. In conclusion, authors would like to highlight the fact that histopathologists need to be familiar with the different types of RCC presenting with a cystic component, as these have prognostic significance. Clinicians also need to be aware that there are certain caveats in the radiological diagnosis of cystic renal neoplasms, and histopathology may often present a different picture from the radiological diagnosis.