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Incidence of Malignancy in Complex Cystic Renal Masses (Bosniak Category III): Should Imaging-Guided Biopsy Precede Surgery?

Mukesh G. Harisinghani1, Michael M. Maher1, Debra A. Gervais1, Francis McGovern2, Peter Hahn1, Kartik Jhaveri3, Jose Varghese1 and Peter R. Mueller1

1 Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.
2 Department of Urology, Massachusetts General Hospital, Boston, MA 02114.
3 Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, 610 University Ave., Toronto, Ontario M5G 2M9, Canada.



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  		Fig. 1. —70-year-old man with renal cell carcinoma. Contrast-enhanced scan CT shows left high-attenuating cyst with uniformly thick wall (arrow). Lesion has increased in size from previous studies (not shown). Biopsy results showed renal cell carcinoma, which was confirmed at surgery.

 


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  		Fig. 2. —62-year-old man with left renal cell carcinoma. Contrast-enhanced CT scan shows exophytic low-attenuating left renal lesion with thickened walls (arrows). Biopsy results showed renal cell carcinoma, which was confirmed at surgery.

 


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  		Fig. 3. —42-year-old woman with inflammatory left renal cyst. Contrast-enhanced CT scan shows multiloculated cystic lesion involving left kidney with thickened septation (straight arrow) and wall (curved arrow). Biopsy results showed inflammatory cyst, which was confirmed at surgery.

 


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  		Fig. 4. —50-year-old woman with inflammatory right renal cyst. Contrast-enhanced CT scan shows multiseptated cyst (large arrows) with mild focal wall thickening (small arrow). Biopsy showed inflammatory cyst, which remained stable in size on radiologic follow-up.

 

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