Difference between revisions of "Localized cystic disease of the kidney"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =
| Width      =
| Caption    =
| Synonyms  =
| Micro      = cysts with cuboidal or flat lining epithelium - contiguous with renal collecting ducts;
renal parenchyma (renal tubules or glomeruli) with in septations; +/-foamy histiocytes; +/-refractile material within the cysts
| Subtypes  =
| LMDDx      = cystic [[renal tumours]] (cystic [[clear cell renal cell carcinoma]], [[cystic nephroma]], [[multilocular cystic renal neoplasm of low malignant potential]]), hereditary [[cystic renal disease]] ([[autosomal dominant polycystic kidney disease]])
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = [[kidney]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = +/-hematuria (uncommon), often [[incidentaloma]]
| Symptoms  = abdominal pain - due to mass effect
| Prevalence = very rare
| Bloodwork  =
| Rads      = localized cystic disease, [[Bosniak classification]] 2 or 3
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = cystic [[renal cell carcinoma]]
| Tx        = excision for diagnosis
}}
'''Localized cystic disease of the kidney''' is a rare benign entity that should be separated from hereditary [[cystic kidney diseases]] and cystic [[renal tumours]].<ref name=pmid23211292>{{Cite journal  | last1 = Ding | first1 = Y. | last2 = Chen | first2 = L. | last3 = Deng | first3 = FM. | last4 = Melamed | first4 = J. | last5 = Fan | first5 = R. | last6 = Bonsib | first6 = S. | last7 = Zhou | first7 = M. | title = Localized cystic disease of the kidney: distinction from cystic neoplasms and hereditary polycystic diseases. | journal = Am J Surg Pathol | volume = 37 | issue = 4 | pages = 506-13 | month = Apr | year = 2013 | doi = 10.1097/PAS.0b013e318271eff9 | PMID = 23211292 }}</ref>
'''Localized cystic disease of the kidney''' is a rare benign entity that should be separated from hereditary [[cystic kidney diseases]] and cystic [[renal tumours]].<ref name=pmid23211292>{{Cite journal  | last1 = Ding | first1 = Y. | last2 = Chen | first2 = L. | last3 = Deng | first3 = FM. | last4 = Melamed | first4 = J. | last5 = Fan | first5 = R. | last6 = Bonsib | first6 = S. | last7 = Zhou | first7 = M. | title = Localized cystic disease of the kidney: distinction from cystic neoplasms and hereditary polycystic diseases. | journal = Am J Surg Pathol | volume = 37 | issue = 4 | pages = 506-13 | month = Apr | year = 2013 | doi = 10.1097/PAS.0b013e318271eff9 | PMID = 23211292 }}</ref>


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*Rare and benign.
*Rare and benign.
*No family history of polycystic kidney disease.
*No family history of polycystic kidney disease.
Presentation:
*Usually an incidental finding (7 of 9 cases).
*Hematuria - uncommon (2 of 9 cases).


Radiology:
Radiology:
*[[Bosniak classification]] 2 or 3.
*[[Bosniak classification]] 2 or 3.
*No cysts in other organs.
*No cysts in other organs - [[liver]], [[pancreas]].


==Gross==
==Gross==
Features:<ref name=pmid23211292/>
Features:<ref name=pmid23211292/>
*Cystic lesion without capsule.
*Focal cystic lesion(s) without a capsule involving the renal papillae +/-renal cortex.
**Contain clear or light-yellow serous fluid.
 
Note:
*''Focal'' - only part of the kidney should be involved.


==Microscopic==
==Microscopic==
Features:<ref name=pmid23211292/>
Features:<ref name=pmid23211292/>
*Cuboidal or flat lining epithelium - contiguous with renal collecting ducts.
*Cysts with cuboidal or flat lining epithelium.
**Contiguous with renal collecting ducts.
*Renal parenchyma (renal tubules or glomeruli) with in (cyst) septations.
*+/-Foamy histiocytes.
*+/-Refractile material within the cysts.
 
Notes - negatives:
*No significant inflammation.
*No significant inflammation.
*No capsule.
*No papillary hyperplasia.


DDx:
DDx:
Line 24: Line 73:
**Cystic [[clear cell renal cell carcinoma]].
**Cystic [[clear cell renal cell carcinoma]].
**[[Cystic nephroma]].<ref name=pmid23132986>{{Cite journal  | last1 = Bhat | first1 = S. | last2 = Thomas | first2 = A. | title = Benign multilocular cyst or multilocular cystic nephroma in adults: three case reports. | journal = Indian J Surg | volume = 69 | issue = 5 | pages = 209-11 | month = Oct | year = 2007 | doi = 10.1007/s12262-007-0025-1 | PMID = 23132986 }}</ref>
**[[Cystic nephroma]].<ref name=pmid23132986>{{Cite journal  | last1 = Bhat | first1 = S. | last2 = Thomas | first2 = A. | title = Benign multilocular cyst or multilocular cystic nephroma in adults: three case reports. | journal = Indian J Surg | volume = 69 | issue = 5 | pages = 209-11 | month = Oct | year = 2007 | doi = 10.1007/s12262-007-0025-1 | PMID = 23132986 }}</ref>
**[[Multilocular cystic renal cell carcinoma]].
**[[Multilocular cystic renal neoplasm of low malignant potential]] - previously known as ''[[multilocular cystic renal cell carcinoma]]''.
*Hereditary [[cystic renal disease]], e.g. [[autosomal dominant polycystic kidney disease]].
*Hereditary [[cystic renal disease]], e.g. [[autosomal dominant polycystic kidney disease]].
==Sign out==
<pre>
Left Kidney, Radical Nephrectomy:
    - Localized cystic disease of the kidney, see microscopic description.
    - NEGATIVE for malignancy.
</pre>
===Micro===
The sections show multiple large cortical cysts. There is relative sparing of the parenchyma in the lower pole. The cyst walls are fibrotic, contain parenchymal remnants and have foci of calcifications. The cyst lining consists of flatted epithelium without appreciable cytoplasm. No cyst lining cell atypia is present. The cyst lining cells are POSITIVE for AE1/AE3 and NEGATIVE for CD34.
Comment:
It is noted that the contralateral kidney is unremarkable on imaging. The findings are in keeping with localized cystic disease of the kidney, a rare benign finding that can mimic a tumour.[1]
1. Am J Surg Pathol 37 (4): 506-13. doi:10.1097/PAS.0b013e318271eff9. PMID: 23211292.


==See also==
==See also==
Line 34: Line 98:


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Kidney tumours]]
[[Category:Genitourinary pathology]]

Latest revision as of 20:30, 8 November 2017

Localized cystic disease of the kidney
Diagnosis in short
LM

cysts with cuboidal or flat lining epithelium - contiguous with renal collecting ducts;

renal parenchyma (renal tubules or glomeruli) with in septations; +/-foamy histiocytes; +/-refractile material within the cysts
LM DDx cystic renal tumours (cystic clear cell renal cell carcinoma, cystic nephroma, multilocular cystic renal neoplasm of low malignant potential), hereditary cystic renal disease (autosomal dominant polycystic kidney disease)
Site kidney
Signs +/-hematuria (uncommon), often incidentaloma
Symptoms abdominal pain - due to mass effect
Prevalence very rare
Radiology localized cystic disease, Bosniak classification 2 or 3
Prognosis benign
Clin. DDx cystic renal cell carcinoma
Treatment excision for diagnosis

Localized cystic disease of the kidney is a rare benign entity that should be separated from hereditary cystic kidney diseases and cystic renal tumours.[1]

It is also known as segmental cystic disease of the kidney, unilateral cystic disease of the kidney[1] and benign multilocular cyst of the kidney.[2]

General

  • Rare and benign.
  • No family history of polycystic kidney disease.

Presentation:

  • Usually an incidental finding (7 of 9 cases).
  • Hematuria - uncommon (2 of 9 cases).

Radiology:

Gross

Features:[1]

  • Focal cystic lesion(s) without a capsule involving the renal papillae +/-renal cortex.
    • Contain clear or light-yellow serous fluid.

Note:

  • Focal - only part of the kidney should be involved.

Microscopic

Features:[1]

  • Cysts with cuboidal or flat lining epithelium.
    • Contiguous with renal collecting ducts.
  • Renal parenchyma (renal tubules or glomeruli) with in (cyst) septations.
  • +/-Foamy histiocytes.
  • +/-Refractile material within the cysts.

Notes - negatives:

  • No significant inflammation.
  • No capsule.
  • No papillary hyperplasia.

DDx:

Sign out

Left Kidney, Radical Nephrectomy:
     - Localized cystic disease of the kidney, see microscopic description.
     - NEGATIVE for malignancy.

Micro

The sections show multiple large cortical cysts. There is relative sparing of the parenchyma in the lower pole. The cyst walls are fibrotic, contain parenchymal remnants and have foci of calcifications. The cyst lining consists of flatted epithelium without appreciable cytoplasm. No cyst lining cell atypia is present. The cyst lining cells are POSITIVE for AE1/AE3 and NEGATIVE for CD34.

Comment: It is noted that the contralateral kidney is unremarkable on imaging. The findings are in keeping with localized cystic disease of the kidney, a rare benign finding that can mimic a tumour.[1]

1. Am J Surg Pathol 37 (4): 506-13. doi:10.1097/PAS.0b013e318271eff9. PMID: 23211292.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 Ding, Y.; Chen, L.; Deng, FM.; Melamed, J.; Fan, R.; Bonsib, S.; Zhou, M. (Apr 2013). "Localized cystic disease of the kidney: distinction from cystic neoplasms and hereditary polycystic diseases.". Am J Surg Pathol 37 (4): 506-13. doi:10.1097/PAS.0b013e318271eff9. PMID 23211292.
  2. ↑ 2.0 2.1 Bhat, S.; Thomas, A. (Oct 2007). "Benign multilocular cyst or multilocular cystic nephroma in adults: three case reports.". Indian J Surg 69 (5): 209-11. doi:10.1007/s12262-007-0025-1. PMID 23132986.
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