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 pa rticular emphasis on prognosis of these problematic cases. In 25 patie nts, an atypical kidney cyst was detected, 36 % of them incidentally b y ultrasound. It was not possible to definitely determine the dignity of these cysts by computer tomography. In addition to ultrasound and c omputer tomography, angiography indicated malignancy in only 1 of 7 ca ses and was therefore no longer utilized in the routine evaluation of cystic kidney tumors. Needle puncture, performed on surgical contraind ication, revealed a carcinoma in 2 out of 3 cases. The intention of th e diagnostic surgery was the primary complete excision of the suspecte d tumor in an organ-sparing manner. Intraoperative histology revealed a carcinoma in only 40 %. In case of malignancy, these tumors were rel atively low staging cystic renal cell carcinomas of differentiated gra des and with a good prognosis. In the mean follow-up period of 28 mont hs, a recurrence of the tumor was found in only one patient. The routi ne evaluation of cystic kidney tumors by means of sonography and CT sc an is considered adequate. Organ sparing surgical evaluation must be p erformed if the possibility of malignancy cannot be completely exclude d by means of the defined criteria.