Rao Kantha, Royce Peter L
Department of Urology, Alfred Hospital, Melbourne, Victoria.
Aust Fam Physician. 2011 Oct;40(10):776-82.
With increasing use of imaging to diagnose other conditions, incidentally detected small renal masses and cysts are now a common clinical scenario for both the general practitioner and the urologist.
This article outlines a diagnostic and management approach to the incidental finding of a small renal mass or cyst.
Renal cell carcinoma represent 2-3% of all cancers and more than 50% of these are detected incidentally. Small renal masses are defined as renal masses less than 4 cm in diameter. They comprise a heterogeneous group of lesions; 20% are benign and only 20-25% prove to be potentially aggressive kidney cancers at the time of diagnosis. Work-up involves a full history, looking for evidence of paraneoplastic syndromes and examination, which is usually normal. Recommended blood tests include basic biochemistry and haematology, and imaging. A four phase contrasted computerised tomography scan of the kidneys allows a detailed examination of each aspect of the functional anatomy of the kidney, which can help approximate risk of malignancy and direct management. Not all patients with small renal masses require a biopsy. However, biopsy is required in patients who opt for active surveillance or ablative therapy. Management options include surveillance, surgery and ablative techniques.
随着用于诊断其他病症的影像学检查使用日益增多，偶然发现的小肾肿块和囊肿如今对于全科医生和泌尿外科医生而言都是常见的临床情况。
本文概述了偶然发现小肾肿块或囊肿的诊断和管理方法。
肾细胞癌占所有癌症的2% - 3%，其中超过50%是偶然发现的。小肾肿块定义为直径小于4厘米的肾肿块。它们包括一组异质性病变；20%为良性，在诊断时只有20% - 25%被证明可能是侵袭性肾癌。检查包括完整的病史，寻找副肿瘤综合征的证据以及体格检查，体格检查通常正常。推荐的血液检查包括基础生化和血液学检查以及影像学检查。肾脏的四期对比计算机断层扫描可以对肾脏功能解剖的各个方面进行详细检查，这有助于评估恶性风险并指导管理。并非所有小肾肿块患者都需要活检。然而，选择主动监测或消融治疗的患者需要进行活检。管理选项包括监测、手术和消融技术。
