A Bosniak III Cyst Unmasking Tubulocystic Renal Cell Carcinoma in an Adolescent: Management with Selective Arterial Clamping and Robotic Enucleation
Marcello Della Corte,
Elisa Cerchia,
Marco Allasia,
Alessandro Marquis,
Alessandra Linari,
Martina Mandaletti,
Elena Ruggiero,
Andrea Sterrantino,
Paola Quarello,
Massimo Catti,
Franca Fagioli,
Paolo Gontero,
Simona Gerocarni Nappo
Affiliations
Marcello Della Corte
Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
Elisa Cerchia
Division of Pediatric Urology, Regina Margherita Hospital, 10126 Turin, Italy
Marco Allasia
Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Corso Bramante 88, 10126 Turin, Italy
Alessandro Marquis
Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Corso Bramante 88, 10126 Turin, Italy
Alessandra Linari
Department of Pathology, Azienda Ospedaliera Città della Salute e della Scienza, 10126 Turin, Italy
Martina Mandaletti
Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
Elena Ruggiero
Division of Pediatric Urology, Regina Margherita Hospital, 10126 Turin, Italy
Andrea Sterrantino
Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
Paola Quarello
Division of Onco-Hematology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children Hospital, 10126 Turin, Italy
Massimo Catti
Division of Pediatric Urology, Regina Margherita Hospital, 10126 Turin, Italy
Franca Fagioli
Division of Onco-Hematology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children Hospital, 10126 Turin, Italy
Paolo Gontero
Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Corso Bramante 88, 10126 Turin, Italy
Simona Gerocarni Nappo
Division of Pediatric Urology, Regina Margherita Hospital, 10126 Turin, Italy
The Bosniak classification of renal cysts aims to provide a probabilistic risk assessment indicating the likelihood of malignancy from imaging findings. Originally designed to classify adult renal cysts based on computed tomography findings, the Bosniak classification has been extended to pediatric patients, with some adjustments made with the aim of accommodating magnetic resonance imaging (MRI) and ultrasonography (US). Bosniak IV lesions are rare in adolescents, indicating localized renal cell carcinoma and requiring surgical intervention. In contrast, Bosniak III lesions can be treated conservatively, although there is a lack of specific guidelines on their management. We present a case of a 14-year-old boy with a Bosniak III lesion, which was incidentally detected during the US evaluation of a left varicocele. After a 12-month follow-up, MRI revealed progression to a Bosniak IV cyst. Robot-assisted tumor enucleation was performed with selective artery clamping when the patient was 15. Histopathology showed tubulocystic renal cell carcinoma without adverse features. Immunocytochemistry supported a favorable prognosis of this rare tumor (<1% of renal tumor), thus obviating the need for adjuvant treatment. At the 18-month follow-up, no recurrence or distant metastasis were observed. This case highlights the importance of an aggressive treatment in persistent Bosniak III and Bosniak IV renal cysts in children and adolescents and the necessity to offer a nephron-sparing surgery.
