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"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."



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On Aug 2018




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




Dr. Mamta Gupta,
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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.


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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%)

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