Multilocular cystic renal neoplasm of low malignant potential: experience of N.N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology

Introduction. Multilocular cystic renal cell neoplasm of low malignant potential (MCRCNLMP) or multilocular cystic renal cell carcinoma (MCRCC) is classified as a distinct nosological unit. Currently, in literature there are no results of studies based on a large number of observations.

Objectives: to systemize clinical and pathomorphological characteristics of MCRCNLMP.

Materials and methods. In the period from January 2011 to December 2015 in the clinic of the N.N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, 32 cases of MCRCNLMP were diagnosed among 588 patients. We have studied clinical and morphological characteristics of this disease, surgical approaches to its treatment, and long-term results, which we present in this article.

Results. MCRCNLMP comprised 5.44 % of all histological cases of RCC. The majority (75 %) of patients didn’t have clinical manifestations of the disease. Т1а tumor stage corresponded to 65.6 % of tumors, Т1b stage to 28.1 %, and Т2 stage only to 6.2 %. In all cases neoplasm was characterized by moderate and mild differentiation (G1–2) per the grading system of the International Society of Urological Pathology (ISUP). Only 25 % of patients had normal body mass index. In 31 of 32 patients, long-term outcomes were observed. Median follow-up duration was 29 (14–66) months. Progression of the disease wasn’t observed in any of the patients.

Conclusion. Patients with MCRCNLMP have the best oncological prognosis among patients with RCC. The necessity of classification of this tumor in accordance with the TNM system is currently dubious. Only organ-preserving surgeries should be used in treatment of the disease. For cases of MCRCNLMP, it is recommended to increase periods of control examinations proposed for patients with RCC, and diagnostic manipulations should be minimal.

1. Злокачественные новообразования в России в 2015 году (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИРЦ» Минздрава России, 2016. 250 с. [Malignant tumors in Russia in 2015 (morbidity and fatality). Eds.: А.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMIRTS” Minzdrava Rossii, 2016. 250 p. (In Russ.)].

2. Ferlay J., Steliarova-Foucher E., Lortet-Tieulent J. et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49(6):1374–403. DOI: 10.1016/j.ejca.2012.12.027. PMID: 23485231.

3. Lopez-Beltran A., Scarpelli M., Montironi R., Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eur Urol 2006;49(5):798–805. DOI: 10.1016/j.eururo.2005.11.035. PMID: 16442207.

4. Bhatt J.R., Jewett M.A., Richard P.O. et al. Multilocular cystic renal cell carcinoma: pathological T staging makes no difference to favorable outcomes and should be reclassified. J Urol 2016;196(5):1350–5. DOI: 10.1016/j.juro.2016.05.118. PMID: 27341751.

5. Li T., Chen J., Jiang Y. et al. Multilocular cystic renal cell neoplasm of low malignant potential: a series of 76 cases. Clin Genitourin Cancer 2016;14(6):553–7. DOI: 10.1016/j.clgc.2016.03.017. PMID: 27108004.

6. Mazzucchelli R., Scarpelli M., Montironi R. et al. Multilocular cystic renal cell neoplasms of low malignant potential. Anal Quant Cytopathol Histpathol 2012;34(5):235–8. PMID: 23301382.

7. Srigley J.R., Delahunt B., Eble J.N. et al. The International Society of Urological Pathology (ISUP) vancouver classification of renal neoplasia. Am J Surg Pathol 2013;37(10):1469–89. DOI: 10.1097/PAS.0b013e318299f2d1. PMID: 24025519.

8. Montironi R., Lopez-Beltran A., Cheng L., Scarpelli M. Multilocular cystic renal cell carcinoma with focus on clinical and pathobiological aspects. Eur Urol 2013;63:400–1.

9. Kuroda N., Ohe C., Mikami S. et al. Multilocular cystic renal cell carcinoma with focus on clinical and pathobiological aspects. Histol Histopathol 2012;27(8):969–74. DOI: 10.14670/HH-27.969. PMID: 22763870.

10. You D., Shim M., Jeong I.G. et al. Multilocular cystic renal cell carcinoma: clinicopathological features and preoperative prediction using multiphase computed tomography. BJU Int 2011;108(9):1444–4. DOI: 10.1111/j.1464-410X.2011.10247.x. PMID: 21722289.

11. Israel G.M., Hindman N., Bosniak M.A. et al. Evaluation of cystic renal masses:

12. comparison of CT and MR imaging by using the Bosniak classification system. Radiology 2004;231(2):365–71. DOI: 10.1148/radiol.2312031025. PMID: 15128983.

13. Pedersen J.F., Emamian S.A., Nielsen M.B. Simple renal cyst: relations to age and arterial blood pressure. Br J Radiol 1993;66(787):581–4. DOI: 10.1259/0007-1285-66-787-581. PMID: 8374720.

14. Gong K., Zhang N., He Z. et al. Multilocular cystic renal cell carcinoma: an experience of clinical management for 31 cases. J Cancer Res Clin Oncol 2008;134(4):433–7. DOI: 10.1007/s00432-007-0302-1. PMID: 17846788.

15. Halat S., Eble J.N., Grignon D.J. et al. Multilocular cystic renal cell carcinoma is a subtype of clear cell renal cell carcinoma. Mod Pathol 2010;23(7):931–6. DOI: 10.1038/modpathol.2010.78. PMID: 20348877.

16. Jhaveri K., Gupta P., Elmi A. et al. Cystic renal cell carcinomas: do they grow, metastasize, or recur? AJR Am J Roentgenol 2013;201(2): 292–6. DOI: 10.2214/AJR.12.9414. PMID: 23883243.

17. Webster W.S., Thompson R.H., Cheville J.C. et al. Surgical resection provides excellent outcomes for patients with cystic clear cell renal cell carcinoma. Urology 2007;70(5):900–4. DOI: 10.1016/j.urology.2007.05.029. PMID: 18068445.

18. Koga S., Nishikida M., Hayashi T. et al. Outcome of surgery in cystic renal cell carcinoma. Urology 2000;56(1):67–70. PMID: 10869626.