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Acquired cystic disease subtype renal cell carcinoma (ACD-RCC): prevalence and imaging features at a single institution

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Acquired cystic kidney disease (ACKD) is commonly seen in patients with end-stage renal disease (ESRD), and patients with ACKD have an increased risk of renal cell carcinoma (RCC). Acquired cystic disease-associated RCC (ACD-RCC) was incorporated into the 2016 World Health Organization Classification. This study aims to describe the imaging features of ACD-RCC, which are not well reported previously.

Methods

Retrospective review of patients with ACKD who underwent total nephrectomy for concern of a renal mass between 2016 and 2021 yielded 122 nephrectomies in 107 patients. Pathology reports were searched for type and subtype of mass. In ACD-RCC subtypes, imaging studies were evaluated for modality and contrast enhancement (CE). Imaging findings assessed included cystic/solid nature, unenhanced CT (NECT) attenuation, enhancement characteristics [non-enhancing (< 10 HU difference), equivocal (10–20 HU), enhancing (> 20 HU)], subjective MRI enhancement, T1 and T2 signal intensity, restricted diffusion, ultrasound (US) echogenicity, and subjective CEUS enhancement.

Results

148 masses were identified, 122 (82%) of which were malignant and 26 (18%) benign. The three most common tumors were clear cell RCC (n = 47), papillary RCC (n = 35), and ACD-RCC (n = 21). Of the 21 cases of ACD-RCC, 16 had preoperative imaging: CT (15: 6 NECT only, 2 CECT only, 7 combined NECT and CECT), MRI (4), CEUS (5). Ten of these tumors were solid/mostly solid and 6 mixed cystic/solid. On NECT, the average attenuation was 35 HU (range 13–52). Of those with multiphasic CTs, 1 was non-enhancing, 3 were equivocal, and 3 enhanced. All 3 masses imaged with CE-MRI showed enhancement. All 4 tumors evaluated by MRI demonstrated T2 hypointensity and restricted diffusion. All five masses enhanced on CEUS.

Conclusion

ACD-RCC subtype was the third most common renal neoplasm in ACKD patients. Our findings found that no single imaging feature is pathognomonic for ACD-RCC. However, ACD-RCCs are typically solid masses with most demonstrating equivocal or mild enhancement on CT. T2 hypointensity and restricted diffusion were the most common MRI features.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Molly B. Carnahan, Akira Kawashima, Bhavik N. Patel, Christine O. Menias & Ghaneh Fananapazir

  2. Mayo Clinic Alix School of Medicine Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA

    Jacqueline Kunzelman

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  1. Molly B. Carnahan
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  2. Jacqueline Kunzelman
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  3. Akira Kawashima
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Contributions

Drs. Carnahan, Kawashima, Patel, Menias, Fananapazir and Jacqueline Anderson, BS all contributed to the 4 ICMJE- listed activities for authorship (substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND drafting the work or revising it critically for important intellectual content; AND final approval of the version to be published; AND agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved).

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Correspondence to Molly B. Carnahan.

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Carnahan, M.B., Kunzelman, J., Kawashima, A. et al. Acquired cystic disease subtype renal cell carcinoma (ACD-RCC): prevalence and imaging features at a single institution. Abdom Radiol 47, 2858–2866 (2022). https://doi.org/10.1007/s00261-022-03566-6

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  • DOI: https://doi.org/10.1007/s00261-022-03566-6

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