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Renal Cyst

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Ashwin Rangavajjula

on 24 January 2013

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Transcript of Renal Cyst

Simple and Complex Renal Cysts: Classification and Treatment

Ashwin Rangavajjula MSIII Literature Cited
Israel GM, Bosniak MA. An update of the Bosniak renal cyst classification system. Urology 2005; 66:484.
Terada N, Ichioka K, Matsuta Y, Okubo K, Yoshimura K, Arai Y. The natural history of simple renal cysts. Urol. 2002;167(1):21.
 
Caglioti A, Esposito C, Fuiano G, Buzio C, Postorino M, Rampino T, Conte G, Dal Canton A. Prevalence of symptoms in patients with simple renal cysts. BMJ. 1993;306(6875):430.
 
Israel GM, Bosniak MA. Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol 2003; 181:627.
Balci NC, Semelka RC, Patt RH, et al. Complex renal cysts: findings on MR imaging. AJR Am J Roentgenol 1999; 172:1495.
Kostiukov SI, Medvedev VL, Kogan MI. [Diagnosis and laparoscopic treatment of renal cysts of Bosniak type III and IV]. Urologiia. 2008 May-Jun;(3):21-4.
 
 
Images:
http://radiopaedia.org/articles/bosniak_renal_cyst_classification Questions? MRI of his abdomen and pelvis to be performed with and without gadolinium Next Step? Category IV

Increasing risk of malignancy (85 to 100%) partial or Radical Nephrectomy
322 patients, 21 with Bosniak III and IV  40 months follow up with no recurrence (6) Management by Category Category III
Obtain Prior Studies
Contrast Enhanced MRI
Partial Nephrectomy
RF ablation for surgical risk/elderly
Category IIF --> III if partial nephrectomy is anatomically possible Management by Category Incidental finding of lesions in the renal parenchyma
Clinical concern: Differentiate between benign and neoplastic lesions & How to manage patients who present renal cysts
Bosniak Classification (1) Simple and Complex Renal Cysts Epidemiology
50% of people over 50 yoa (2)
More common in men
Found on U/S, CT – incidentally, unrelated to suspected pathology
Clinical Features
Typically asymptomatic
Solitary, multiple or bilateral
Rarely associated with rupture, hematuria, pain, abdominal mass, infection, hypertension(3) Simple Renal Cysts The Contaminator Category IIF
Category IIF require follow up imaging (Hence the letter “F”)
Obtain prior imaging, do follow up CT (4)
Quality contrast-enhanced MRI (5)
Serial examinations at 3, 6, and 12 months
Mural irregularity and mural enhancement
Percutaneous needle biopsies
Provide diagnosis in 80% of patients Management by Category Repeat U/S at 6 to 12 months
Follow-up imaging if clinician unable to differentiate between Category II and IIF Category I and II Management by Category Clearly malignant, solid mass with large cystic or necrotic component 
Contain enhancing soft-tissue components that are adjacent to and independent of the wall or septum
Work up: to be discussed Bosniak Category IV Indeterminate cystic masses
Thick or multiple septations, mural nodule, hyperdense on CT
Work up : to be discussed
Cysts are not clearly benign or malignant Bosniak Category III Multiple hairline thin/minimal thickening of the wall
Thick and nodular calcification of the wall or septa
No measurable contrast enhancement is present
Intrarenal, nonenhancing > 3cm
Work up: To be discussed Bosniak Category IIF Simple cyst
Thin wall without septa, calcification, solid components
Work up: None
Tx: Pain Infection or HTN - Rare
Bosniak Category I A few hairline thin septa.
There is no measurable enhancement
High attenuation < 3cm non enhancing, well marginated
Work up: None Bosniak Category II 74 year old male incidental finding Bosniak IIF renal cyst on a cross fused ectopic kidney
No major associated symptoms
AUA score: 8
IIEF: 47, normal DRE
Renal Cyst: No change in renal cyst inferior left kidney since 2005. Increased size with slightly thickened septation from 12/2011. CT done as well.
Next STEP? Patient AM
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