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Complex Renal Cyst
Ankur Pandey, MD; Barton F. Lane, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Renal cystic mass
          • Definitions

            • Benign, fluid-filled nonneoplastic renal lesion not meeting criteria of simple renal cyst
              • Bosniak classes II, IIF, and III
            • Related to complications of simple renal cyst: Hemorrhage, infection, ischemia
            • Simple and complex cysts are most common renal masses in adults (62%)

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Qiu X et al: How does contrast-enhanced ultrasonography influence Bosniak classification for complex cystic renal mass compared with conventional ultrasonography? Medicine (Baltimore). 99(7):e19190, 2020
                                        2. Arif-Tiwari H et al: Classification and diagnosis of cystic renal tumors: role of MR imaging versus contrast-enhanced ultrasound. Magn Reson Imaging Clin N Am. 27(1):33-44, 2019
                                        3. Silverman SG et al: Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment. Radiology. 292(2):475-88, 2019
                                        4. Bertolotto M et al: Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol. 105:41-8, 2018
                                        5. Barr RG: Is there a need to modify the Bosniak renal mass classification with the addition of contrast-enhanced sonography? J Ultrasound Med. 36(5):865-8, 2017
                                        6. Nicolau C et al: Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound. Abdom Imaging. 40(3):542-51, 2015
                                        7. Wood CG 3rd et al: CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics. 35(1):125-41, 2015
                                        8. Barr RG et al: Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology. 271(1):133-42, 2014
                                        9. Cokkinos DD et al: Contrast enhanced ultrasound of the kidneys: what is it capable of? Biomed Res Int. 2013:595873, 2013
                                        10. McArthur C et al: Current and potential renal applications of contrast-enhanced ultrasound. Clin Radiol. 67(9):909-22, 2012
                                        11. Quaia E et al: Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol. 191(4):1239-49, 2008
                                        12. Park BK et al: Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol. 61(2):310-4, 2007
                                        13. Israel GM et al: An update of the Bosniak renal cyst classification system. Urology. 66(3):484-8, 2005
                                        14. Hartman DS et al: From the RSNA refresher courses: a practical approach to the cystic renal mass. Radiographics. 24 Suppl 1:S101-15, 2004
                                        15. Laven BA et al: Malignant B-cell lymphoma in renal cyst wall. Urology. 64(3):590, 2004
                                        16. Ho VB et al: Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology. 224(3):695-700, 2002
                                        17. Jamis-Dow CA et al: Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology. 198(3):785-8, 1996
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Renal cystic mass
                                                • Definitions

                                                  • Benign, fluid-filled nonneoplastic renal lesion not meeting criteria of simple renal cyst
                                                    • Bosniak classes II, IIF, and III
                                                  • Related to complications of simple renal cyst: Hemorrhage, infection, ischemia
                                                  • Simple and complex cysts are most common renal masses in adults (62%)

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Qiu X et al: How does contrast-enhanced ultrasonography influence Bosniak classification for complex cystic renal mass compared with conventional ultrasonography? Medicine (Baltimore). 99(7):e19190, 2020
                                                                              2. Arif-Tiwari H et al: Classification and diagnosis of cystic renal tumors: role of MR imaging versus contrast-enhanced ultrasound. Magn Reson Imaging Clin N Am. 27(1):33-44, 2019
                                                                              3. Silverman SG et al: Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment. Radiology. 292(2):475-88, 2019
                                                                              4. Bertolotto M et al: Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol. 105:41-8, 2018
                                                                              5. Barr RG: Is there a need to modify the Bosniak renal mass classification with the addition of contrast-enhanced sonography? J Ultrasound Med. 36(5):865-8, 2017
                                                                              6. Nicolau C et al: Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound. Abdom Imaging. 40(3):542-51, 2015
                                                                              7. Wood CG 3rd et al: CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics. 35(1):125-41, 2015
                                                                              8. Barr RG et al: Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology. 271(1):133-42, 2014
                                                                              9. Cokkinos DD et al: Contrast enhanced ultrasound of the kidneys: what is it capable of? Biomed Res Int. 2013:595873, 2013
                                                                              10. McArthur C et al: Current and potential renal applications of contrast-enhanced ultrasound. Clin Radiol. 67(9):909-22, 2012
                                                                              11. Quaia E et al: Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol. 191(4):1239-49, 2008
                                                                              12. Park BK et al: Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol. 61(2):310-4, 2007
                                                                              13. Israel GM et al: An update of the Bosniak renal cyst classification system. Urology. 66(3):484-8, 2005
                                                                              14. Hartman DS et al: From the RSNA refresher courses: a practical approach to the cystic renal mass. Radiographics. 24 Suppl 1:S101-15, 2004
                                                                              15. Laven BA et al: Malignant B-cell lymphoma in renal cyst wall. Urology. 64(3):590, 2004
                                                                              16. Ho VB et al: Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology. 224(3):695-700, 2002
                                                                              17. Jamis-Dow CA et al: Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology. 198(3):785-8, 1996