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Complex renal Cyst

kumar_rk21
Posts: 2
Joined: Apr 2007

I am 31 years old male. In Dec 2004, I had burning sensation while urinating. On urine test, microscopic hematuria was found. A string of tests were done including CT scan of abdomen without contrast and everything came out normal.
In Nov 2006, a Ultrasound scan found an incidental complex renal cyst in the lower pole of my right kidney. A subsequent CT scan diagnosed it as a minimally complex renal cyst (Bosniak category II) which is probably benign. Needless to say, I was shocked and went back to my radiologist with my earlier scan films (the one taken in Dec 2004). He was able to see the renal cyst clearly even though the other radiologist in Dec 2004 missed it.

Now, as a part of follow-up, a MRI was done (different hospital this time) and the radiologist reports that there appears to be partial enhancement of the lesion which would be concerning for renal cell carcinoma.

Also, within a span of 5 months, the cyst has increased in size from 3 CM to 3.8 CM

Is there anyone out there with similar radiology readings. While my urologist and radiologist are still discussing, I would like to know my chances.

What are the chances that this is RCC and if yes, what is the prognosis. I still have microscopic hematuria (on and off).

Any input would be appreciated.

Thanks
Krishna

pcarey
Posts: 1
Joined: May 2007

Hi
I'm a 63 year old male that has had a Bosnaik II cyst on left kidney and RCC on right kidney. The Drs. I consulted with were not confident that they could tell if the cyst was benign so I went to the Cleveland Clinic where a DR Gill performed a laproscopic partial nephectomy in Nov 2001. The cyst was benign. Out of the Hospital in 3 days and back to work in 7. We began to check the progress of the tumor on the right kidney every 6 months. It had grown to 3.8 cm by fall of 2004 so back to CC and DR Gill to have it removed. It was RCC.
All of this stuff was discovered incidentially as is so often the case, I slipped on the ice in February 2001 and went to the DR because my back hurt. The ability to determine finding has not kept up with the rate that incidents are found.
As a side Bar. I was DR Gill's 71st laproscopic in 2001 and his 345th in 2004. The man is the best.
My suggestion to you is to have the cyst removed. As was expressed to me by all Doctors I consulted.
"There is only one sure way to find out if you have cancer, have surgery.

kumar_rk21
Posts: 2
Joined: Apr 2007

Thanks for all your feedback. I wanted to give a quick update.
1) After I posted the message, I learned further that my cyst in the CT and MRI had the same characteristics and size. That means the cyst didn't grow in five months.
2. So in April 2007, I sent my reports to Dr. Bosniak, who gracefully accepted to reivew my case. He suggested to upgrade the cyst to IIF. He and my urologist agreed that MRI can show additional enhancement and decided to follow it up as the doubtful area within the cyst is very minimal.
3. First week of July 2007, took one more MRI as a 3 month follow up and the cyst looks exactly the same.
4. Anyway, I am meeting up with Dr. Gill on July 31st. I am taking your advice and along with Dr. Gill's, I will ask for removing it.

Thanks again for all your support. I will keep the forum posted after my appointment with Dr. Gill.

Kris

little momma
Posts: 1
Joined: Jun 2010

Hi Kris and all - I need your input. Iwas evaluated by a urologist after 2 ultrasounds 6 months apart showed a small increase in size in a kidney cyst - and the 2nd showed internal echoes.
A CT Scan with contrast had the radiologist stating 2F and my urologist saying a definite 3 on the Bosniak scale - said it had to come out.
Lap surgery he took it out - said he looked at it and was simple - did NOT send to pathology - I was told this was an urgent surgery - why wouldn't he send it to pathology?
He did remove a perfectly healthy adrenal gland and was suppossed to remove an adrenal mass - did send the adrenal gland and a tiny bit of adipose tissue identified as adrenal - and both fine.
I want to think I am ok - thankful for a great report - but it is difficult - since he had told me he would definitely send off the kidney cyst - since it was so small - a tiny bit would be looked at during surgery - but either way - it would be sent off.
What do you all think?
Thanks for your comments.

trishpm
Posts: 22
Joined: Nov 2004

You have more to gain by having a partial nephrectomy, and a lot to lose by waiting. Complex cysts can have small pockets of RCC within them that are very difficult to characterize with CTs or MRIs. Enhancement is frequently a sign of RCC; CTs done to characterize indeterminate renal masses should be done with contrast. Pcarey's Dr. Gill is among the very best surgeon's for laparascopic partial nephrectomies, but there are other doctors skilled in this new (but growing more frequent) procedure. If there are small foci of RCC in your complex cyst, and you have it removed, you will most likely be rid of the RCC beast for life, and your will have normal kidney function. If you wait until it gets bigger, the chances of you being home free after nephrectomy are smaller.

Chicago's picture
Chicago
Posts: 74
Joined: Apr 2004

I gotta agree with PCarey. I went in 4 years ago for a kidney stone, and they found a similar complex cyst in a pole of my kidney (35 at the time). Lit up on the scale as a 2 without enhancement, but a 3 with enhancement. The results were thus "inconclusive."

My doc though (Steven Campbell, also now at Cleveland), actually gave me a 20% odds it was RCC. I figured that was enough risk to have the surgery. Good thing too. The odds became 100% once they were able to test what they took out.

Don't mess with it -- especially if it's changing that fast (I hope you've done something about it by now). And if you can go to Cleveland, all the better. They are the only ones doing partial nephrectomies laporoscopically (I had the full operation -- no fun).

HeatherHa
Posts: 16
Joined: May 2011

Hi, I know your post is old, but, among others, based on your posts, we are seriously considering Cleveland Clinic. Please contact me. I wanted to understand whether you had a laparascop partial nephrectomy and what size? In our case, it is pretty big - almost 7cm

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