Diagnosis

Diagnosis

Acquired cystic disease-associated renal cell carcinoma.

Discussion

The gross examination demonstrates an enlarged kidney (320 g) with multiple cysts. A few well-circumscribed solid nodules with dark-red to tan-yellow cut surfaces were noted. A dominant 3.4 cm yellow-tan to tan-red, partially cystic mass grossly abutting the renal sinus was identified. Patients with end-stage renal disease who undergo long-term hemodialysis may develop multiple cortical cysts. This is probably the result of obstruction and calcium-oxalate deposition in chronic renal failure. The number of cysts is usually less than the cysts with autosomal-dominant polycystic kidney disease (ADPKD) but more than simple renal cysts. There is an increased risk for the development of renal cell carcinoma. Acquired cystic disease-associated RCC is the most common subtype of RCC in end-stage kidneys with acquired cystic disease. The tumor is often multifocal and can be bilateral. It is usually well circumscribed with a thick fibrous capsule or can appear to arise from within a cyst with a tan to yellow cut surface with hemorrhage and necrotic or friable areas. The differential for the mass includes renal cell carcinoma (RCC), the most common malignant tumor of the kidney. The two most common subtypes of RCC are clear cell RCC (70-80%) and papillary RCC (10-15%). Clear cell RCCs demonstrate a yellow cut surface with areas of necrosis and hemorrhage, and are partially cystic. Papillary RCCs are usually well-circumscribed, gray-white lesions with central necrosis and hemorrhage. Both tumors are usually single and unilateral but can be multiple and bilateral.

References

Pandey J, Syed W. Renal Cancer. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558975.
Srigley, John R. MD*; Delahunt, Brett MD†; Eble, John N. MD‡; Egevad, Lars MD, PhD§; Epstein, Jonathan I. MD∥; Grignon, David MD‡; Hes, Ondrej MD, PhD¶; Moch, Holger MD#; Montironi, Rodolfo MD**; Tickoo, Satish K. MD††; Zhou, Ming MD, PhD‡‡; Argani, Pedram MD§§ The ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. The American Journal of Surgical Pathology 37(10):p 1469-1489, October 2013. | DOI: 10.1097/PAS.0b013e318299f2d1
 

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