Presentation
Non-specific abdominal pain. Microscopic hematuria. Poor urinary stream.
Patient Data
In the superoposterior aspect of the left kidney, a 46 mm partially exophytic cystic mass with a thick calcified wall and internal eccentric enhancing nodules with a maximum diameter of 15 mm is noted.
Additionally, a few non-enhanced simple cortical cysts, with maximum diameters of 28 mm, are seen in both kidneys. A 5 mm stone is also noted in the middle calyx of the right kidney.
The prostate gland is enlarged.
Degenerative changes as osteophytosis are seen at the lumbar spine.
Grade I spondylolisthesis of L4 on L5 is present.
Case Discussion
The left cystic renal mass indicates a Bosniak class IV lesion due to enhancing nodules and is highly suggestive of malignancy, particularly renal cell carcinoma.
It should reminded that, according to the Bosniak classification 2019, if the enhancing solid component volume of a renal cystic lesion is more than 25% of all mass volume, the Bosniak classification should not be used, and the mass should be instead categorized as a solid renal mass with cystic/necrotic changes; because a solid renal cell carcinoma with cystic/necrotic changes has a poor prognosis compared to the renal cell carcinoma that is arising from a Bosniak class IV cystic renal mass.