DIAGNOSTIC AND SURGERY FOR CYSTIC TUMORS OF THE KIDNEY

The diagnostic differentiation of cystic tumors of the kidney can, in some cases present a clinical challenge. Patients subjected to surgery because of such findings were evaluated and discussed with regard to the pre- and intraoperative diagnostic and surgical procedures with particular emphasis on prognosis of these problematic cases. In 25 patients, an atypical kidney cyst was detected, 36 % of them incidentally by ultrasound. It was not possible to definitely determine the dignity of these cysts by computer tomography. In addition to ultrasound and computer tomography, angiography indicated malignancy in only 1 of 7 cases and was therefore no longer utilized in the routine evaluation of cystic kidney tumors. Needle puncture, performed on surgical contraindication, revealed a carcinoma in 2 out of 3 cases. The intention of the diagnostic surgery was the primary complete excision of the suspected tumor in an organ-sparing manner. Intraoperative histology revealed a carcinoma in only 40 %. In case of malignancy, these tumors were relatively low staging cystic renal cell carcinomas of differentiated grades and with a good prognosis. In the mean follow-up period of 28 months, a recurrence of the tumor was found in only one patient. The routine evaluation of cystic kidney tumors by means of sonography and CT scan is considered adequate. Organ sparing surgical evaluation must be performed if the possibility of malignancy cannot be completely excluded by means of the defined criteria.