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Follow-Up CT of Moderately Complex Cystic Lesions of the Kidney (Bosniak Category IIF)

¹ Both authors: NYU Medical Center, Ste. HW 202, 560 First Ave., New York, NY 10016.

View larger version (141K): [in a new window]   Fig. 1. —66-year-old man with moderately complex category IIF cyst in right kidney. Axial contrast-enhanced CT scan shows 2-cm cystic mass in right kidney that has mildly thickened wall (arrow). Septa are noted within lesion. Follow-up examinations (not shown) performed up to 3 years later revealed no change in this lesion. Note simple cyst in posterior right kidney with thin imperceptible wall.

View larger version (150K): [in a new window]   Fig. 2. —56-year-old man with moderately complex category IIF cyst in left kidney. Axial contrast-enhanced CT scan shows 3-cm complex cystic mass in left kidney. Wall of lesion (straight arrow) is slightly thickened, and few hairline-thin septations (curved arrow) are present. Follow-up examinations (not shown) performed up to 6 years 6 months later showed no change in appearance of this lesion.

View larger version (145K): [in a new window]   Fig. 3. —86-year-old man with complex cystic category IIF mass in left kidney. Axial contrast-enhanced CT scan shows 4-cm complex cystic mass in left kidney that has thickened wall (long straight arrow) containing small amount of calcification (short straight arrow) (calcification score = 1). Also notice thin septation (curved arrow). Follow-up examinations (not shown) performed up to 2 years later revealed no change in lesion.

View larger version (142K): [in a new window]   Fig. 4. —45-year-old woman with intrarenal high-attenuation cyst (category IIF). Axial unenhanced CT scan shows 3-cm intrarenal high-density cyst that has slightly indistinct posterior interface (arrow) with kidney. Patient also underwent contrast-enhanced examination (not shown), and multiple region-of-interest measurements were performed and showed no evidence of enhancement in any part of lesion. This lesion was stable at follow-up examinations performed up to 3 years 6 months later.

View larger version (133K): [in a new window]   Fig. 5. —68-year-old man with calcified cystic renal mass (category IIF). Axial contrast-enhanced CT scan shows 1.5-cm complex cystic mass that has thick and nodular calcified wall (calcification score = 3), but no evidence of soft-tissue enhancement is present. Follow-up examinations (not shown) through 5 years revealed no change in mass or amount of calcification.

View larger version (150K): [in a new window]   Fig. 6A. —30-year-old man with category IIF mass in left kidney. Axial contrast-enhanced CT scan shows 2-cm cystic mass contains mildly thickened septation (arrow).

View larger version (141K): [in a new window]   Fig. 6B. —30-year-old man with category IIF mass in left kidney. Follow-up contrast-enhanced CT scan obtained 4 years 7 months after A shows that mass has grown to 2.5 cm. However, septation is no longer visible, and lesion appears less complex.

View larger version (154K): [in a new window]   Fig. 7A. —65-year-old man with complex category IIF cystic mass in right kidney. Axial contrast-enhanced CT scan shows 3-cm complex cystic mass in right kidney that has moderately thickened septation (arrow). Although this lesion was originally classified as category IIF, irregular thickening of septum (arrow) is visible posteriorly; this finding suggests that category III might have been more appropriate category for this lesion than category IIF.

View larger version (151K): [in a new window]   Fig. 7B. —65-year-old man with complex category IIF cystic mass in right kidney. Follow-up contrast-enhanced CT scan obtained 1 year 4 months after A shows that septa and wall have become thicker and lesion is more complex. These findings indicate its malignant nature. This lesion proved to be cystic renal cell carcinoma. Two-year follow-up examination (not shown) performed after surgery revealed no evidence of recurrent disease.

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