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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 7
| Issue : 1 | Page : 21-22 |
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Multilocular cystic renal cell carcinoma: An entity not to be forgotten
Kriti Chauhan1, Rujuta Shah2
1 Department of Pathology, Polo Labs, Ivy Hospital, Panchkula, Haryana, India
2 Department of Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| Date of Submission | 14-Oct-2019 |
| Date of Decision | 15-Nov-2019 |
| Date of Acceptance | 02-Dec-2019 |
| Date of Web Publication | 24-Aug-2021 |
Correspondence Address:
Dr. Kriti Chauhan
Polo Labs, Ivy Hospital, Panchkula, MDC, Sector 5C, Panchkula - 134 112, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jina.jina_10_19
How to cite this article:
Chauhan K, Shah R. Multilocular cystic renal cell carcinoma: An entity not to be forgotten. J Integr Nephrol Androl 2020;7:21-2 |
Dear Editor,
Cystic neoplasms of the kidney are a broad category comprising both benign and malignant types, which can be confused with one another on clinical and radiological grounds. Even the gross appearance can mimic one another. In such instances, histopathology proves to be of great help in differentiating provided certain defining features are kept in mind. One such neoplasm is multilocular cystic renal cell carcinoma (MRCC), which is known to have a low malignant potential in comparison to more commonly occurring conventional renal cell carcinoma (CRCC) with cystic change.[1],[2] MRCC is of special importance because though it is labeled as a carcinoma, it has never shown metastasis and has an excellent prognosis. Because of its rarity (1%–2% of all renal tumors), it is not known to many physicians and pathologists due to which it is often overdiagnosed as CRCC and overtreated.[2] We present one such case of MRCC highlighting its specific light microscopic findings. A 42-year-old male presented with pain in the right lumbar region and hematuria for 1 month. Ultrasonography revealed a cyst in the middle pole of the right kidney. Contrast-enhanced computed tomography demonstrated a Bosniak Category III complex cystic lesion in view of which a right nephrectomy was performed. On gross examination, the kidney was well encapsulated and measured 10 cm × 9 cm × 5cm. On bisection, a well-encapsulated cystic mass was identified in the middle pole measuring 2.2 × 1.5 having blood-filled spaces separated by thin septa. Histological examination showed an encapsulated multiloculated cystic tumor filled with secretions and hemorrhage [Figure 1]. At places, the fibrous septa were lined by single and multiple layers of clear cells having well-defined cytoplasmic borders and Grade 1 nuclei with inconspicuous nucleoli [Figure 2] and [Figure 3]. No focus of invasion, necrosis was seen. Renal capsule, vessels, perinephric fat, and renal sinus were free of tumor. Nonneoplastic kidney showed features of chronic pyelonephritis. A diagnosis of MRCC (pT1aN0M0) (tumor node metastasis staging) was given. Till date (2 years postsurgery), the patient has no complaints and is free of disease. Malignancy is noted in over 50% of Bosniak III lesions. In a study by Mousessian et al., 68% and 18% of Bosniak III lesions were found to be CRCC and MRCC, respectively.[3] Malignancy in both types is attributed to “clear cells,” but it is the architectural pattern and nuclear grade that differentiates the two. Presence of intercommunicating expansile nodules of clear cells breaching the fibrous septa, presence of papillary growth pattern and infiltration into stroma beyond the capsule along with necrosis favours CRCC over MRCC. None of these features were seen in our case. In fact, MRCC is considered to be a localized subtype of CRCC, which requires only surgical excision. Both of them harbor 3p deletion.[4] Apart from this, clear cells can also be seen in a lot more benign and malignant lesions such as cystic nephroma and tubulocystic carcinoma, but the architecture, cytology, and stroma are very different from MRCC.[5] The pathologists and clinicians should be well versed with this entity so that any unwanted therapy (chemo/radio) and the anxiety due to its misinterpretation as CRCC can be avoided. | Figure 1: Low power view showing cysts filled with secretions (blue arrow) and multiple layers of clear cells(black arrow) adherent to the septa (×100, H and E)
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 | Figure 2: Low power view showing a thick fibrous capsule around the tumor (red arrow), nonneoplastic renal tissue outside the capsule (yellow arrow) and tumor cells (black arrow) (×100, H and E)
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 | Figure 3: High power view highlighting the architecture and cytological details of tumor cells having low nuclear grade and well-defined cytoplasmic borders (×400, H and E)
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Acknowledgment
The authors are thankful to the technical staff, head of the Department of pathology, and chairman of hospital for their help and support in the making of this article.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Agarwal S, Agrawal U, Mohanty NK, Saxena S. Multilocular cystic renal cell carcinoma: A case report of a rare entity. Arch Pathol Lab Med 2011;135:290-2.  |
| 2. | Chowdhury AR, Chakraborty D, Bhattacharya P, Dey RK. Multilocular cystic renal cell carcinoma a diagnostic dilemma: A case report in a 30-year-old woman. Urol Ann 2013;5:119-21. [ PUBMED] [Full text] |
| 3. | Mousessian PN, Yamauchi FI, Mussi TC, Baroni RH. Malignancy rate, histologic grade, and progression of bosniak category iii and iv complex renal cystic lesions. AJR Am J Roentgenol 2017;209:1285-90. |
| 4. | Wahal SP, Mardi K. Multilocular cystic renal cell carcinoma: A rare entity with review of literature. J Lab Physicians 2014;6:50-2. [ PUBMED] [Full text] |
| 5. | Hu J, Jin L, Li Y, He T, Liu J, Shi B, et al. Multilocular cystic renal cell carcinoma: A case report and review of the literature. Mol Clin Oncol 2018;8:326-9. |
[Figure 1], [Figure 2], [Figure 3]
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