To facilitate the case discussion, Dr. Ficarra presented two cases. The first was a 54-year old female with no comorbidities who presented with an incidentally detected complex 2cm Bosniak II lesion in the left kidney. Given the known incidence of malignancy at 20-25% in these lesions, the patient was followed with interval imaging. At 24 months, the tumor had increased in size and complexity to a 4cm Bosniak III lesion. At this point, Dr. Ficarra took time to recommend against biopsy in this population since the sensitivity approaches only 83%. Given the more than 50% chance of malignancy for Bosniak III lesions, the patient was taken to surgery where a partial nephrectomy was performed. Final pathology demonstrated clear cell renal cell carcinoma, Fuhrman grade 2, pT1a with negative surgical margins.
Case two was a 63-year old male patient with an asymptomatic Bosniak III lesions. Again, given the high risk of malignancy, the patient was taken to surgery where a partial nephrectomy was performed. Final pathology represented a multilocular cystic renal cell carcinoma. Recent data have demonstrated favorable survival outcomes in these patients (Bhatt et al. J Urol 2016;196: 1350).
In conclusion, Dr. Ficarra noted that CT, MRI, and contrast-enhanced US represent the diagnostic tools to characterize cystic renal lesions. Category IIF lesions must be followed, while, category III/IV lesions are high-risk for malignancy and must be resected (unless patient is not a surgical candidate). Partial nephrectomy should be recommended in this tumor with preferential consideration favoring a minimally invasive approach. Lastly, multilocular cystic renal cell carcinomas usually have an excellent prognosis.
Presented by: Vincenzo Ficarra, MD
Written By: Benjamin T. Ristau, MD, Fox Chase Cancer Center, Philadelphia, PA
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA