Presentation
Hematuria
Patient Data
Age: 60 years
Gender: Male
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Cystic lesion (<25% solid) arising from the atrophic right kidney which shows multiple enhancing convex protrusions peripherally. Some of these measure > 4mm so are consistent with nodules and a Bosniak IV classification.
Case Discussion
This cystic lesion illustrates how convex protrusions with obtuse margins which are >4mm are classified as "nodules" which is a feature of a Bosniak IV classification according to the 2019 update to the Bosniak classification 1.
The large majority of Bosniak IV masses are malignant and this was referred to the cancer MDT.
The patient underwent total nephrectomy and the histology showed a 54mm papillary renal cell carcinoma ISUP nuclear grade 2 Stage (TNM8): pT3a, R0.
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