與腎臟腫瘤鑑別困難之良性出血性腎囊泡之影像檢討與分析
劉家翔1、陳威任
1,2,3、黃子豪
1,2,3、魏子鈞
1,2,3、鍾孝仁
1,2,3、張延驊
1,2,3、黃志賢
1,2,3
台北榮民總醫院泌尿部1國立陽明大學醫學系泌尿學科2書田泌尿科學研究中心3
Benign renal hemorrhagic cyst mimicking renal neoplasm
Chia-Hsiang Liu1, Wei-Jen Chen
1,2,3, Tzu -Hao Huang 1,2,3,Tzu-Chun Wei 1,2,3,Hsiao-Jen Chung
1,2,3, , Yen-Hwa Chang
1,2,3 Williams J. Huang
1,2,3
1 Department of Urology; Taipei Veterans General Hospital, Taiwan
2 Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
3Shu-Tien Urological Institute
Objective:
Hemorrhagic renal cyst is an image diagnosis that we often met in our daily practice. However, for a complicated renal cyst, even we have CT/MRI image now, it’s still difficult to correctly differentiate benign hemorrhagic cyst from renal neoplasm in some cases. We searched cases in past twenty years from our surgical pathology database, and review the characteristics of those renal hemorrhagic cysts, which were indistinguishable from renal neoplasm on image.
Materials and Methods:
We retrospectively reviewed our surgical pathology database to enroll all patients with hemorrhagic renal cysts with initial impression of renal neoplasm. From 2000 to 2019, total 9 patients were enrolled.
Results:
9 patients were enrolled. Mean lesion size on image was 6.7cm (range 3.5-19.8cm), with one lesion unmeasurable due to rupture with bleeding. According to the Bosniak classification, three patients were with class III lesion, five patients with class IV lesions (one unmeasurable). Two patients received radical nephrectomy due to ESRD, one patient received radical nephrectomy due to large tumor(19.8cm) and six patients received partial nephrectomy. The surgery was performed under impression of r/o cystic RCC in 6 patients, and r/o AML in 3 patients. After reviewing patients’ image, surgery is still considered.
Conclusion:
For a cystic renal lesion, Bosniak classification, clinical symptom, lesion size were still the guide for surgeon to evaluate the surgical indication. Even for a Bosniak grade 4 image, there’s still exception that the lesion was benign. These tumors were not suitable for biopsy, so careful and detailed patient consultation before surgery is mandated.