囊性肾癌误诊为肾囊肿临床分析OA

Objective To analyze the causes of misdiagnosis of cystic renal cell carcinoma as renal cysts and the preventive measures against such misdiagnosis.Methods A retrospective analysis was conducted on the clinical characteristics,imaging data,and pathological features of 4 patients with cystic renal cell carcinoma who were misdiagnosed with renal cysts from December 2020 to December 2024.Results Among the 4 patients,1 patient presented with dull lumbar pain,1 presented with abdominal mass,and the remaining 2 were detected incidentally during physical examinations.All 4 cases were initially diagnosed as renal cysts based on imaging examinations.After finding atypical cells through percutaneous renal puncture cytology,one patient underwent surgery for a confirmed diagnosis.The diagnosis was confirmed during the operation through rapid pathology in one patient.In 1 patient,the cyst failed to respond to multiple puncture and drainage treatments and repeatedly enlarged,and the patient was confirmed by surgical exploration.One patient underwent surgery for a confirmed diagnosis after enhanced CT and MRI examinations,and the pathological type was renal clear cell carcinoma.The time of misdiagnosis ranged from 7 d to 3 years.After diagnosis,1 patient underwent partial nephrectomy initially and then converted to radical nephrectomy due to the pathological results suggesting cancer,1 patient underwent direct radical nephrectomy after intraoperative confirmation,and 2 patients underwent partial nephrectomy.There was no recurrence during the 6-month to 1-year postoperative follow-up,and the renal function remained stable.Conclusion The imaging manifestations of cystic renal cell carcinoma and renal cysts are highly similar,and the clinical misdiagnosis rate is high.The Bosniak classification system has limitations in the differentiation of grade ⅡF to Ⅲ lesions,and it is necessary to combine multimodal imaging(such as MRI,contrast-enhanced ultrasound)and dynamic follow-up to improve the diagnostic accuracy.For suspected cases,doctors should be vigilant of malignant signs such as thickened cyst walls and solid components.Early puncture biopsy or surgical exploration should be performed,if necessary,and the analysis of imaging features,the optimization of Bosniak classification application,and the improvement of clinical vigilance are recommended to reduce misdiagnosis and improve the prognosis of patients.