Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 298181

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : ED22 - ED24 Full Version

Rare Case of Multilocular Cystic Renal Neoplasm of Low Malignant Potential with Chronic Pyelonephritis


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/50166.15290
Mrunal Kesari, Shweta Agrawal, Yoganand Patil, Indranil Bhattacharya, Monica Dholpure

1. Consultant Pathologist, Junior DNB Faculty, Department of Pathology and Laboratory Medicine, Jagjivanram Western Railway Hospital, Mumbai, Maharashtra, India. 2. Senior Resident, Department of Pathology and Laboratory Medicine, Jagjivanram Western Railway Hospital, Mumbai, Maharashtra, India. 3. Head, Senior DNB Faculty, Department of Pathology and Laboratory Medicine, Jagjivanram Western Railway Hospital, Mumbai, Maharashtra, India. 4. Additional Chief Medical Director, Department of Pathology, Western Railway, Mumbai, Maharashtra, India. 5. Junior Resident, Department of Pathology and Laboratory Medicine, Jagjivanram Western Railway Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Shweta Agrawal,
Senior Resident, Department of Pathology and Laboratory Medicine,
Jagjivanram Western Railway Hospital, Mumbai-400008, Maharashtra, India.
E-mail: shwetaagarwal1991.sa@gmail.com

Abstract

Multilocular Cystic Renal Neoplasm of Low Malignant Potential (MCRNLMP) represents a rare variant of clear cell (conventional) renal carcinoma. They constitute between 3-6% of clear cell Renal Cell Carcinoma (RCC). The RCC constitutes less than 1% of all renal tumours. The MCRNLMP has an excellent prognosis with no reports of recurrence or metastasis. Authors reported a case of 67-year-old male patient on account of its rarity, co-existing pyelonephritis and incidental detection of MCRNLMP. Differentiation between MCRNLMP, RCC variants and other cystic lesions with clear cells is important as prognosis, treatment differ markedly. Radiological Bosnaik classification of complex cysts in category IIF and III is challenging and requires microscopic examination for correct diagnosis. Histopathology shows cysts separated and fibrous septae having groups of clear cells with low grade nuclei. Immunohistochemistry with Carbonic Anhydrase-IX (CA-IX), Epithelial Membrane Antigen (EMA), Cytokeratin (CK7) and CD10 is confirmatory. Diagnosis requires detailed imaging studies, meticulous grossing of nephrectomy specimens, extensive sampling of cystic tissue to find clear cells and immunohistochemistry (IHC).

Keywords

Bosniak classification, Complex renal cystic lesions, Immunohistochemistry

Case Report

A 67-year-old male presented in surgical Outpatient Department (OPD) with pain in abdomen for two weeks. He had a history of recurrent urinary tract infection and hernia. There was no other significant medical history. He had soft reducible inguinal swelling on left side. Inguinal hernia reduction surgery was planned. As a part of preoperative work up abdominal ultrasonography was done. Left kidney showed cystic lesion near the hilum. Hence, Contrast Enhanced Computed Tomography (CECT) was advised. It showed a multilobulated septated cystic lesion and heterogeneously enhancing cystic nodule involving posteromedial cortex of middle 1/3rd of left kidney, suggestive of neoplasm (Table/Fig 1). Provisional diagnosis was renal cell carcinoma in underlying chronic pyelonephritis. The patient underwent left radical nephrectomy.

Pathology laboratory received the specimen. Grossly, the left kidney along with perinephric fat measured 9.5×5.5×4.5 cm and ureter 1.0 cm in length. Left side adrenal and lymph nodes not identified. Cut surface of the kidney showed a well circumscribed multiloculated cystic lesion measuring 3×2.5×1 cm, situated near the hilum of the kidney. Thin septae were seen in between the cysts (Table/Fig 2)a,b.

Microscopy showed variably sized, non communicating cysts lined by flattened to cuboidal epithelium with clear cytoplasm. The septae showed clear cells. They had well defined cell borders with abundant clear cytoplasm and uniform round to oval hyperchromatic nuclei and inconspicuous nucleoli (Fuhrman Nuclear Grade 1). Cyst lumen was filled with eosinophilic secretions (Table/Fig 3)a,b. Lymphovascular invasion was not seen. Surrounding renal parenchyma showed glomerular sclerosis, thyroidisation of renal tubules. Interstitium showed vascular wall thickening, fibrosis and lymphoplasmacytic infiltrate.

Microscopically, differential diagnosis of clear cell rich cystic lesions of the kidney was cystic nephroma, clear cell papillary RCC, tubulocystic carcinoma, clear cell rich RCC with cystic degeneration and Multilocular Cystic Renal Neoplasm of Low Malignant Potential (MCRNLMP). The IHC with CD68 was done to rule out macrophages in xanthogranulomatous pyelonephritis as the patient had recurrent urinary tract infection. Tumour cells showed immunoreactivity with Carbonic Anhydrase-IX (CA-IX) (Table/Fig 4)a, cytokeratin (CK7).(Table/Fig 4)b, Epithelial Membrane Antigen (EMA) (Table/Fig 4)c, and negative staining of CD10. (Table/Fig 4)d and CD68. Renal cut margin including renal vein, renal artery and ureter, as well as Gerota’s fascia were free of tumour. The histopathological features along with IHC confirmed the diagnosis of MCRNLMP co-existing in chronic pyelonephritis. The patient is stable and in good condition and without any recurrence till now.

Discussion

In clinical practice renal cysts are commonly encountered incidental findings. Cystic lesions comprise a wide spectrum of hereditary, acquired, developmental, and neoplastic conditions. Differential diagnosis are polycystic kidney disease, unilateral renal cystic disease, renal simple cysts, multicystic dysplastic kidney, pluricystic kidney of the multiple malformation syndromes, juvenile nephronophthisis and medullary cystic disease, medullary sponge kidney, glomerulocystic kidney disease, cystic kidney in tuberous sclerosis, and in von Hippel-Lindau syndrome, cystic nephroma, cystic variant of congenital mesoblastic nephroma, mixed epithelial stromal tumour of the kidney, renal lymphangioma, pyelocalyceal cyst, peripelvic cyst and perinephric pseudocyst, acquired renal cystic disease of long term dialysis, and cystic renal cell carcinoma and sarcoma (1). Most of the cysts are benign simple cysts. Renal cystic lesions are common cause of end stage renal disease in adults.

Multilocular Cystic Renal Neoplasm of Low Malignant Potential (MCRNLMP) is a rare variant of clear cell (conventional) renal carcinoma. It accounts for less than 1% of all renal tumours. Most of the cases were discovered incidentally as overt symptoms of renal mass were usually absent (2). The term Renal Cell Carcinoma (RCC) is obsolete now and MCRNLMP is the preferred term in the latest WHO classification of tumours of the urinary system and male genital organs (2016) (2). According to World Health Organisation (WHO) 2016 classification, diagnostic criteria of MCRNLMP are as follows:

a) Tumour containing multiple cysts with low grade tumour cells (ISUP-International Society of Urological Pathology/WHO grade 1/2).
b) Cysts are lined by a single layer of tumour cells of low grade with abundant clear cytoplasm.
c) Septae contains few clusters of clear cells with non expansile growth.

Several studies report no recurrence or metastasis in patients after surgical treatment. Surgical resection is curative (2),(3),(4). Cystic nephroma, clear cell papillary renal cell carcinoma with predominant cystic configuration, tubulocystic carcinoma of the kidney, benign multilocular renal cortical cyst have to be differentiated from MCRNLMP (2). The MCRNLMP is differentiated from cystic nephroma according to location and arrangement of clear cells lining the septa. Focal presence of the lining clear cells and characteristic ovarian-like stroma seen in cystic nephroma. Cystic clear cell papillary RCC has clear cells in papillary architecture in most areas and linear arrangement of nuclei away from basement membrane; a feature not found in MCRNLMP (5). The CA-IX immunostaining pattern also differs. Diffuse membranous box-like positivity seen in MCRNLMP while diffuse membranous cup shaped (sparing luminal border of tumour cells) positivity seen in other (6). Tubulocystic carcinoma shows small to medium sized tubules lined by tumour cells with high grade nuclei. Oncocytic change with hobnailing can also be seen. The intervening septa are fibrotic. These cells express CD10, Alpha-Methylacyl-CoA Racemase (AMACR) and sometimes CK7 and High Molecular Weight Cytokeratin (HMWCK) with less than half expressing CA-IX (4). Regressing Clear Cell (RCC) with cystic degeneration has more than 75% cystic areas with expansile growth of clear cells (7). Clear cells have to be distinguished from macrophages. Nuclear features, cell arrangement and IHC with CD68 help in differentiation.

The differentiation between simple benign and complicated cystic renal lesions remains a major challenge in modern imaging. The incidental detection of cystic renal lesions has increased due to the more widespread use of cross-sectional imaging techniques (8). The Bosniak classification categorises renal cysts into Category I, II, IIF, III, or IV discovered via computed tomography (9). When a cystic lesion has more than three or four septa, it should be considered a multilocular cyst. The cyst wall and septa are grossly thickened (≥2 mm), nodules, thick or irregular calcifications can be present (10). Nodular and septal enhancements in cystic tumours are highly sensitive for differentiation between RCC and MCRNLMP. Renal cortex extension can be found in cystic RCC (11). Sometimes clear cut differentiations between Categories IIF and III are not as obvious as those between other categories. Contrast Enhanced Ultrasound (CEUS) is superior to unenhanced ultrasound and Computed Tomography (CT) scan in diagnosing malignancy in complex cystic renal masses using features such as the presence of septa, thickenings in walls and/or septa, and solid components. The CEUS has lower costs, fast availability, and an excellent safety profile (8),(12),(13).

Imaging guided percutaneous core needle biopsies of indeterminate complex cystic renal lesions (Category III) are not reliable. The target tumour cells in the cyst wall may not be sampled and leading to false negative results. Biopsies can be used in selective cases having poor general condition to avoid surgery and based on when imaging studies are complete (14).

Conclusion

Multilocular cystic renal neoplasm of low malignant potential is a rare entity. Correct diagnosis of complex cystic renal lesions is challenging. Histopathological examination is diagnostic. Differentiation between MCRNLMP and other cystic lesions with clear cells is important as the prognosis and treatment of lesions varies tremendously. It requires a high degree of suspicion of malignancy, detailed imaging studies, meticulous grossing of nephrectomy specimens, extensive sampling of cystic tissue to find clear cells and IHC.

References

1.
Bisceglia M, Galliani CA, Senger C, Stallone C, Sessa A. Renal cystic diseases: A review. Adv Anat Pathol. 2006;13(1):26-56. [crossref] [PubMed]
2.
Moch H, Cubilla AL, Humphrey PA, Reuter VE. WHO Classification of Tumours of the Urinary System and Male Genital Organs, fourth edition, World health Organization classification of Tumours. International agency for research in cancer, Lyon, France, 2016, pp. 11-76 Chapter 1. [crossref] [PubMed]
3.
Srigley JR, Delahunt B, Eble JN, Egevad L, Epstein JI, Grignon D, et al. ISUP Renal Tumour Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013;37(10):1469-89. [crossref] [PubMed]
4.
Jagtap SV. Multilocular cystic renal neoplasm-low malignant potential (MCRN-LMP)- review. Ann Urol Oncol. 2020;3(2):97-102.
5.
Gobbo S, Eble JN, Grignon DJ, Martignoni G, MacLennan GT, Shah RB, et al. Clear cell papillary renal cell carcinoma: A distinct histopathologic and molecular genetic entity. Am J Surg Pathol. 2008;32:1239-45. [crossref] [PubMed]
6.
Zhao J, Eyzaguirre E. Clear cell papillary renal cell carcinoma. Arch Pathol Lab Med. 2019;143(9):1154-58. [crossref] [PubMed]
7.
Zhang W, Li Y, Lu Q, Zhuang J, Wang Q, Zhao H, et al. Clinicopathologic features and differential diagnosis of multilocular cystic renal cell carcinoma. Zhonghua Bing Li Xue Za Zhi. 2014;43(11):723-27.
8.
Schnitzer ML, Sabel L, Schwarze V, Marschner C, Froelich MF, Nuhn P, et al. Structured reporting in the characterization of renal Cysts by Contrast-Enhanced Ultrasound (CEUS) using the bosniak classification system-improvement of report quality and interdisciplinary communication. Diagnostics (Basel). 2021;11(2):313. [crossref] [PubMed]
9.
Bosniak MA. The Bosniak renal cyst classification: 25 years later. Radiology. 2012;262:781e5. [crossref] [PubMed]
10.
Helenon O, Delavaud C, Dbjay J, Gregory J, Rasouli N, Correas JM, et al. A practical approach to indeterminate and cystic renal masses. Semin Ultrasound CT MR. 2017;38:10e27. [crossref] [PubMed]
11.
Freire M, Remer EM. Clinical and radiologic features of cystic renal masses. Am J Roentgenol. 2009;192:1367e72. [crossref] [PubMed]
12.
Quaia E, Bertolotto M, Cioffi V, Rossi A, Baratella E, Pizzolato R, et al. Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. Am J Roentgenol. 2008;191:1239e49. [crossref] [PubMed]
13.
Park BK, Kim B, Kim SH, Ko K, Lee HM, Choi HY, et al. Assessment of cystic renal masses based on Bosniak classification: Comparison of CT and contrast-enhanced US. Eur J Radiol. 2007;61:310e4. [crossref] [PubMed]
14.
Bata P, Tarnoki AD, Tarnoki DL, Szasz AM, Poloskei G, Fejer B, et al. Bosniak category III cysts are more likely to be malignant than we expected in the era of multidetector computed tomography technology. J Res Med Sci. 2014;19(7):634-38.

DOI and Others

10.7860/JCDR/2021/50166.15290

Date of Submission: Apr 30, 2021
Date of Peer Review: Jun 01, 2021
Date of Acceptance: Jun 27, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 01, 2021
• Manual Googling: Jun 13, 2021
• iThenticate Software: Jul 31, 2021 (20%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com