What are the diagnoses of cystic renal cancer

Cystic renal cell carcinoma is a relatively rare cystic tumor in renal cell carcinoma. The literature reports that its incidence rate varies, accounting for about 4% to 5% of renal cancer, and is more common in adult males. Its clinical manifestations may include low back pain, gross hematuria, abdominal mass, etc. Some patients have no obvious symptoms and signs, and are accidentally discovered during physical examinations. So how to diagnose cystic renal cell carcinoma?

The cause of cystic renal cell carcinoma The cause of cystic renal cell carcinoma is still unclear. There are four possible related factors: (1) The tumor grows in a cystic manner, with varying amounts of blood in the cyst, and the tumor often forms a pseudocapsule; (2) The central blood supply of renal cell carcinoma is insufficient, and bleeding and necrosis occur to form pseudocysts with thick and irregular walls; (3) Renal cell carcinoma originates from cyst epithelial cells and grows in a nodular or papillary manner, with nodules often located at the base of the cyst; (4) Renal cell carcinoma causes obstruction of the renal tubules or renal arterioles, leading to cyst formation, and when the tumor grows, it is embedded in the cyst. From the perspective of pathogenesis, cystic renal cell carcinoma is divided into four categories: cystic necrosis type, unilocular cystic renal cell carcinoma type, multilocular cystic renal cell carcinoma type, and simple cystic carcinoma type.

Diagnosis of Cystic Kidney Cancer

The diagnosis of cystic renal cell carcinoma mainly relies on imaging examinations, and B-ultrasound and CT can be used as the main means of examination. B-ultrasound is simple and practical and can be used for general surveys. The ultrasound characteristics of typical cystic renal cell carcinoma are uneven thickness of the cyst wall, and the echo-free area in the cyst is filled with dense point-like weak echoes, which are caused by necrotic tissue debris and fresh or old bleeding. Color ultrasound examination can reveal solid parts in the cyst or color blood flow signals on the partitions. However, B-ultrasound is difficult to make an accurate diagnosis of cystic renal cell carcinoma due to interference from multiple factors such as the operator's technical level, obesity, and abdominal gas, but it can provide clues to renal cystic or cystic-solid tumors.

Treatment of cystic renal cell carcinoma Cystic renal cell carcinoma has a low pathological stage and grade, and the surgical treatment effect is satisfactory and the prognosis is good. Ninety percent of cases have a survival period of more than 15 years. The author believes that for cystic renal cell carcinoma, if the diagnosis is clear, radical nephrectomy should be performed; for suspected cases, surgical exploration should be performed, and simple cyst enucleation or nephrectomy should not be selected during the operation. The cystic mass and the surrounding renal tissue should be removed for pathological examination. Once the pathology confirms cystic renal cell carcinoma, radical nephrectomy should be performed. However, some authors believe that for localized renal cell carcinoma with a diameter of less than 4 cm, nephron-preserving surgery is clinically recommended, which can achieve the same effect as radical surgery. In this group, patients with a clear diagnosis underwent radical nephrectomy directly; those with a suspected diagnosis underwent tumor enucleation. One patient was reported to be malignant and was changed to radical nephrectomy. Another patient was diagnosed with a benign tumor during surgery, and the postoperative pathological paraffin section confirmed that it was renal clear cell carcinoma. One patient diagnosed with renal cyst underwent laparoscopic cyst decompression and found irregular thickening of the cyst wall. The frozen section was diagnosed as a malignant tumor and was also changed to radical nephrectomy. Cystic renal cancer has a good prognosis. However, some people believe that cystic renal cancer is not much different from traditional renal cancer, which may be related to different case selection criteria.

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