|Year : 2002 | Volume
| Issue : 2 | Page : 152-153
Multilocular cystic renal cell carcinoma (MLCRC): A rare clinical entity
Tulasi Prasad Mohapatra, Ramesh Chandra Rath, Kamala Kanta Panigrahi
Department of Urology, M. K C. G. Medical College, Berhampur, Gunjam, India
Tulasi Prasad Mohapatra
M.K.C.G. Medical College, Berhampur, Dist. Ganjan (Orissa)- 760 004
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Multilocular cystic renal cell carcinoma (MLCRC) is a low-grade tumour which arises from cystic lesions in the renal parenchvma. High index of suspicion, helps to detect this tumour in otherwise benign cystic lesions. Nephron-sparing suugery can be implemented in pre-operatively diagnosed cases.
Keywords: Cystic Carcinoma; Renal Cell Carcinoma; Cystic Renal Cell Carcinoma.
|How to cite this article:|
Mohapatra TP, Rath RC, Panigrahi KK. Multilocular cystic renal cell carcinoma (MLCRC): A rare clinical entity. Indian J Urol 2002;18:152-3
| Introduction|| |
Multilocular cystic renal cell carcinoma is a rare clinicopathological entity, reported sporadically in English literature. Younger age group is commonly affected. The benign behaviour of the tumor makes it more prone for missing the neoplastic pathology. Computerised axial tomography is the most valuable investigation to establish the diagnosis.
| Case Report|| |
A 26-year-old lady presented with right renal mass and intermittent right flank pain over a period of 2 years. She denied associated weight loss, fever or hematuria. Physical examination revealed palpable right renal lump. Blood parameters were within normal limits. Ultrasonography showed a well circumscribed cystic lesion occupying lower pole of right kidney. Aspiration of cyst yielded clear yellow fluid and cytology excluded presence of malignant cells in cyst fluid. CAT scan revealed a large well defined cystic mass arising from lower pole of right kidney with numerous thick (more than l mm) septations inside. No septal or mural calcification seen [Figure - 1]. The patient was subjected to (Rt) radical nephrectomy and the post-op period was eneventful. The cut surface of the specimen shows multiple thin-walled cystic lesions with clear yellow coloured fluid [Figure - 2]. Histopathology demonstrated clear vascuolated cells with pleomorphic nuclei (grade-2 nuclear appearance) seen in alveolar septae arranged in alveolar and trabecular pattern with delicate vasculature [Figure - 3]. The patient is asymptomatic and free of tumour for last two and half years.
| Discussion|| |
Multilocular cystic renal cell carcinoma is an unifocal diffusely multiloculated cystic neoplasm with less than 10% solid areas.  The tumour is composed of Grade-I to II clear cells and extension beyond the kidney and distant metastasis has not been reported.  Absence of malignant cells in aspirated cyst fluid does not exclude malignancy, as the tumor is present in the cyst wall and compressed solid areas in between the cysts.
The criteria to diagnose MLCRC are:
(i) An expansile mass surrounded by a fibrous wall, (ii) interior of the tumour is composed of cysts and septae with no expansile solid nodules, (iii) septae contain aggregates of epithelial cells with clear cytoplasm. As it is a low grade localised tumor, correct pre-operative diagnosis will facilitate nephron sparing surgery, so that total nephrectomy can be avoided.
| References|| |
|1.||Murad T. Komaiko W. Pyasu R, Bauer K. Multilocular cystic renal cell carcinoma. Am J Clin Path 1991: 95: 633-637. |
|2.||Elbe JN. Bansib SM. Extensively cystic neoplasms: Cystic nephroma. cystic partially differentiated nephroblastoma, multilocular cystic renal cell carcinoma and cystic hamartoma of renal pelvis. Semin Diagn Pathol 1998: 15: 2-29. |
|3.||Hayakawa M, Hatanot, Tsuji A, Nakajima F. Ogawa Y. Patients with renal cysts associated with renal cell carcinoma and the clinical implications of cyst puncture : a study of 223 cases. Urology 1996; 47: 643-646. |
|4.||Weiss SG. Hafez RG. Uehling DT. Multilocular cystic renal cell carcinoma: implications for nephron sparing surgery. Urology 1998: 51: 635-637. |
[Figure - 1], [Figure - 2], [Figure - 3]