Answer for BIR CoW 21 Jan 2024
Multilocular cystic nephroma
Findings
Evidence of well-defined T1 hypointense, T2 hyperintense multiloculated cystic lesion noted arising from the lower pole of left kidney showing no diffusion restriction. On contrast administration, the capsules and septa of the lesion are enhanced. The lesion measures approximately 6.7 (anteroposterior) x 8.1 (transverse) x 7.8 (craniocaudal) cm and is seen herniating into the renal hilum. On delayed imaging, caliectasis of the upper pole of the left kidney was noted. The right kidney appears normal and measures 9.6 x 4.4 cm.
Discussion
Cystic nephromas, previously known as Multilocular cystic nephromas. Non-hereditary benign renal neoplasm arising from metanephric blastema containing stromal and epithelial components. Bimodal age distribution - affecting young children and adults in middle age. Classically occurring in adult females in the 4th and 5th decades. Clinical features – Hematuria, abdominal flank pain, palpable mass Complications – Obstructive uropathy, infection, haemorrhage Imaging features – Radiography – Large abdominal mass displacing and effacing adjacent bowel loops. IVP – Depending on the size and location of mass may present with or without pelvicaliectasis. USG – Large multiloculated cystic mass with multiple hyperechoic septa and hyperechoic fibrous capsule. CECT – Capsular and septal enhancement and rarely calcifications can be seen. Distortion of the collecting system with or without obstruction. MRI - T1W – Multiloculated hypointense mass (clear fluid) with variable signal intensity (blood or protein) T2W – Hyperintense (clear fluid) or variable (blood or protein) with hypointense capsule and septa (fibrous tissue) T1W C+ = Enhancement of the septa and the capsule Excretory urogram – Delayed imaging can reveal caliectasis.
Differential diagnosis – Cystic renal cell carcinoma Cystic Wilm’s tumor Localized cystic renal disease Multicystic dysplastic kidney Renal cortical cyst
Findings
Evidence of well-defined T1 hypointense, T2 hyperintense multiloculated cystic lesion noted arising from the lower pole of left kidney showing no diffusion restriction. On contrast administration, the capsules and septa of the lesion are enhanced. The lesion measures approximately 6.7 (anteroposterior) x 8.1 (transverse) x 7.8 (craniocaudal) cm and is seen herniating into the renal hilum. On delayed imaging, caliectasis of the upper pole of the left kidney was noted. The right kidney appears normal and measures 9.6 x 4.4 cm.
Discussion
Cystic nephromas, previously known as Multilocular cystic nephromas. Non-hereditary benign renal neoplasm arising from metanephric blastema containing stromal and epithelial components. Bimodal age distribution - affecting young children and adults in middle age. Classically occurring in adult females in the 4th and 5th decades. Clinical features – Hematuria, abdominal flank pain, palpable mass Complications – Obstructive uropathy, infection, haemorrhage Imaging features – Radiography – Large abdominal mass displacing and effacing adjacent bowel loops. IVP – Depending on the size and location of mass may present with or without pelvicaliectasis. USG – Large multiloculated cystic mass with multiple hyperechoic septa and hyperechoic fibrous capsule. CECT – Capsular and septal enhancement and rarely calcifications can be seen. Distortion of the collecting system with or without obstruction. MRI - T1W – Multiloculated hypointense mass (clear fluid) with variable signal intensity (blood or protein) T2W – Hyperintense (clear fluid) or variable (blood or protein) with hypointense capsule and septa (fibrous tissue) T1W C+ = Enhancement of the septa and the capsule Excretory urogram – Delayed imaging can reveal caliectasis.
Differential diagnosis – Cystic renal cell carcinoma Cystic Wilm’s tumor Localized cystic renal disease Multicystic dysplastic kidney Renal cortical cyst
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!