肾脏囊性占位.pptxVIP

肾脏囊性占位第1页/共36页 肾脏囊性占位2013-11第2页/共36页 IntroductionIgnore, Follow or ExciseRadiological InterpretationCalcificationHyperdense or High signalSeptationsEnhancementMultiloculatedNodularityWall thickeningRole of BiopsyDr Bosniaks opinionBosniak Classification of Renal Cystic Disease第3页/共36页 Renal cysts are commonly encountered lesions in daily radiological practice.?Usually these are simple benign cysts, but they can become complicated in case of hemorrhage, infection and ischemia.?When this occurs it can be difficult to differentiate these complicated cysts from cystic renal cell carcinomas (10% of all renal cell carcinomas)?Since the only treatment for renal cell carcinoma is surgery or ablation, we need to recognize these cystic renal cell carcinomas.Imaging is a reliable means for differentiating benign from malignant cystic lesions.第4页/共36页 Even on gross examination a cystic renal cell carcinoma (left) may be indistinguishable from a complicated cyst (right) 第5页/共36页 Ignore, Follow or ExciseRenal cysts can be classified according to the Bosniak classification depending on their features.?Type I?cysts are simple cysts.Type II?are the minimally complicated cysts.?Type I and II can be ignored.?Type II F?are probably benign, but need to be followed.?Type III and IV?both are surgical lesions.?Type IV is inevitably malignant and in the type III group about 80-90% turn out to be malignant as well.In our communication with the clinicians it is important, that we explain the significance of our findings and the meaning of the classification in terms of: Ignore (type I and II), Follow (type IIF) or Excise (type III and IV).So in this lecture we will only talk about Ignore, Follow or Excise.For those who want to see the original Bosniak classification, look at the table which is presented at the end of the lecture.第6页/共36页 第7页/共36页 Radiological InterpretationAlthough the final differentiation of cystic renal masses is based upon histologic diagnosis, the