| 词条 | Renal cyst | |||||||||||||||||||||||||||||||||||||||||||||||||
| 释义 |
| name = Renal cyst | synonyms = | image = File:Renal cyst MRI.jpg | caption = Renal cyst of the left kidney (hyperintense area) as shown on MRI. | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} A renal cyst or kidney cyst, is a fluid collection in or on the kidney. There are several types based on the Bosniak classification. The majority are benign, simple cysts that can be monitored and not intervened upon. However, some are cancerous or are suspicious for cancer and are commonly removed in a surgical procedure called nephrectomy. Numerous renal cysts are seen in the cystic kidney diseases, which include polycystic kidney disease and medullary sponge kidney. Bosniak classificationRenal cysts are classified by malignant risk using the Bosniak Classification System. The system was created by Dr. Morton Bosniak, a faculty member at the New York University Langone Medical Center in New York City.[1] The Bosniak classification categorizes renal cysts into five groups.[2] Category IBenign simple cyst with thin wall without septa, calcifications, or solid components. It does not enhance with contrast, and has a density of 0–20 Hounsfield units[3] (about equal to that of water).Category II Benign cyst with a few thin septa, which may contain fine calcifications or a small segment of mildly thickened calcification. This includes homogenous, high-attenuation (60–70 Hounsfield units[3]) lesions less than 3 cm with sharp margins but without enhancement. Hyperdense cysts must be exophytic with at least 75 percent of its wall outside the kidney to allow for appropriate assessment of margins, otherwise they are categorized as IIF.[4]Category IIF This category includes renal cysts with multiple thin septa, a septum thicker than hairline, slightly thick wall, or with calcification, which may be thick. It also includes intrarenal cysts larger than {{convert|3|cm|abbr=off}} if:
Category IIF cysts have a 5-10% risk of being kidney cancer, and therefore follow-up is recommended. However, there is no consensus recommendation on the appropriate interval of follow up.[5] Category IIIIndeterminate cystic masses with thickened irregular septa with enhancement. 50 percent of these lesions are ultimately found to be malignant.Category IV Malignant cystic masses with all the characteristics of category III lesions but also with enhancing soft tissue components independent of but adjacent to the septa. 100 percent of these lesions are malignant.
WorkupThe complex cyst can be further evaluated with doppler ultrasonography, and for Bosniak classification and follow-up of complex cysts, either contrast-enhanced ultrasound (CEUS) or contrast CT is used.[7] TreatmentThis system is more directly focused on the most appropriate management. These alternatives are broadly to ignore the cyst, schedule follow-up or perform a surgical excision of it. When a cyst shows discrepancy in severity across categories, it is the most worrisome feature that is used in deciding about management. There is no established rule regarding the follow-up frequency, but one possibility is after 6 months, which can later be doubled if unchanged.[8]
Peripelvic versus parapelvic cystsParapelvic cysts originate from around the kidney at the adjacent renal parenchyma, and plunge into the renal sinus. Peripelvic cysts are contained entirely within the renal sinus, possibly related to dilated lymphatic channels. When viewed on CT in absence of contrast, they can mimic hydronephrosis.[9] If symptomatic, they can be laparoscopically decorticated - removal of the outer layer or cortex.[10] EpidemiologyUp to 27 percent of individuals greater than 50 years of age may have simple renal cysts that cause no symptoms.[11] See also
References1. ^http://urology.med.nyu.edu/conditions-we-treat/renal-cysts 2. ^{{cite journal |vauthors=Curry NS, Cochran ST, Bissada NK |title=Cystic renal masses: accurate Bosniak classification requires adequate renal CT |journal=American Journal of Roentgenology |volume=175 |issue=2 |pages=339–42 |date=August 2000 |pmid=10915671 |doi= 10.2214/ajr.175.2.1750339|url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=10915671}} 3. ^1 2 3 4 {{cite journal|last1=Muglia|first1=Valdair F.|last2=Westphalen|first2=Antonio Carlos|title=Classificação de Bosniak para cistos renais complexos: histórico e análise crítica|journal=Radiologia Brasileira|volume=47|issue=6|year=2014|pages=368–373|issn=0100-3984|doi=10.1590/0100-3984.2013.1797}} 4. ^{{cite journal|pmid=25741060|pmc=4337166|year=2014|author1=De Miranda|first1=C. M.|title=Bosniak classification of renal cystic lesions according to multidetector computed tomography findings|journal=Radiologia Brasileira|volume=47|issue=2|pages=115–21|last2=Maranhão|first2=C. P.|last3=Dos Santos|first3=C. J.|last4=Padilha|first4=I. G.|last5=De Farias Lde|first5=P|last6=Da Rocha|first6=M. S.|doi=10.1590/S0100-39842014000200015}} 5. ^1 {{cite web|url=http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20160721214452544321|title=Bosniak classification of renal cystic disease|website=GPnotebook|accessdate=2017-05-17}} 6. ^{{cite journal|last1=Muglia|first1=Valdair F.|last2=Westphalen|first2=Antonio Carlos|title=Classificação de Bosniak para cistos renais complexos: histórico e análise crítica|journal=Radiologia Brasileira|volume=47|issue=6|year=2014|pages=368–373|issn=0100-3984|doi=10.1590/0100-3984.2013.1797}} 7. ^1 {{cite journal|last1=Hansen|first1=Kristoffer|last2=Nielsen|first2=Michael|last3=Ewertsen|first3=Caroline|title=Ultrasonography of the Kidney: A Pictorial Review|journal=Diagnostics|volume=6|issue=1|year=2015|pages=2|issn=2075-4418|doi=10.3390/diagnostics6010002}} [https://creativecommons.org/licenses/by/4.0/ (CC-BY 4.0)] 8. ^1 2 3 {{cite web|url=http://www.radiologyassistant.nl/en/p44d1045b472df/kidney-cystic-masses.html|title=Kidney - Cystic masses|author=David S. Hartman, MD and Ileana Chesaru, MD.|website=Radiology Assistant|accessdate=2017-10-20}} 9. ^{{cite journal|pmid=9107666|year=1997|author1=Zinn|first1=H. L.|title=Peripelvic cysts simulating hydronephrosis|journal=Abdominal Imaging|volume=22|issue=3|pages=346–7|last2=Becker|first2=J. A.}} 10. ^{{cite journal|pmid=16879687|year=2006|author1=Shiraishi|first1=K|title=Laparoscopic decortication of symptomatic simple renal cysts: 10-year experience from one institution|journal=BJU International|volume=98|issue=2|pages=405–8|last2=Eguchi|first2=S|last3=Mohri|first3=J|last4=Kamiryo|first4=Y|doi=10.1111/j.1464-410X.2006.06249.x}} 11. ^{{cite journal |vauthors=Tada S, Yamagishi J, Kobayashi H, Hata Y, Kobari T |title=The incidence of simple renal cyst by computed tomography |journal=Clinical Radiology |volume=34 |issue=4 |pages=437–9 |date=July 1983 |pmid=6872451 |doi= |url=}} External links{{Medical resources| DiseasesDB = | ICD10 = {{ICD10|N|28||q|1}} | ICD9 = {{ICD9|593.2}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = med | eMedicineTopic = 453831 | MeshID = }}{{Portal|Medicine}} 1 : Kidney diseases |
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