Presentation
Right flank pain, nausea and hematuria for one day. No history of fever or vomiting.
Patient Data
There is a calculus measuring 4.5 mm (average density = 245 HU) in the distal right ureter. It is associated with mild proximal hydroureteronephrosis and mild right perinephric fat stranding.
There is also a well-defined hypodensity measuring about 4.3 x 4.4 cm (average density = 21 HU) at the upper pole of the right kidney, which is likely a renal cortical cyst.
There is a well-defined septated cystic lesion measuring 5.0 x 6.7 cm at the upper pole of the right kidney. A few tiny, faint calcifications are seen within it. The post-contrast study shows enhancement in the irregular septations as well as in the walls of the cyst. No soft tissue or hemorrhagic component is seen.
A few proximal jejunal loops show diffuse mural thickening and intense enhancement of the valvulae conniventes.
Impression: multiseptated cystic lesion at the upper pole of the right kidney, which is likely a Bosniak type 3 cyst. Diffusely thickened proximal jejunal loops with enhanced valvulae conniventes; inflammatory/infective enteritis.
Procedure: open partial nephrectomy.
Diagnosis: multilocular cystic renal neoplasm of low malignant potential (previously known as multilocular clear cell renal cell carcinoma). Fuhrman nuclear grade: Grade 1. Maximum tumor size: 5 cm (gross). Renal parenchymal excision margins: clear lymphovascular space invasion: not identified. Capsular and extra-capsular invasion: not identified.
Pathological staging: pT1b, pNx, pMx.
Case Discussion
Multilocular cystic renal neoplasm of low malignant potential, or MCRCC, is an infrequent variant of clear cell renal cell carcinoma (RCC). It is a low-grade tumor and has a favorable outcome 1.
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