Aditya M, Chowdhary Sujit K, Kashyap Vikas
Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India.
Department of Histopathology, Indraprastha Apollo Hospitals, New Delhi, India.
J Indian Assoc Pediatr Surg. 2023 Jan-Feb;28(1):75-79. doi: 10.4103/jiaps.jiaps_71_22. Epub 2022 Dec 12.
Multiloculated cystic renal masses are uncommon in the pediatric population. The presentation may be as an asymptomatic incidental finding on imaging, abdominal mass, abdominal pain, or urinary tract infection. The differentiation between benign and malignant causes of a cystic lesion by clinical and radiological examination is difficult. Tru-cut biopsy is not recommended due to fear of upgrading a malignant tumor. A definitive diagnosis is confirmed histopathologically only after surgery. Based on certain imaging characteristics, benign nature can be suspected and a conservative approach to surgery can be contemplated to save the kidney. Frozen section biopsy is useful in ruling out malignancy while doing nephron-sparing surgery (NSS) in these patients. NSS may be done by an open or minimally invasive approach. After histological confirmation of cystic nephroma, no other adjuvant treatment is necessary, but long-term surveillance is strongly recommended.
多囊性肾肿块在儿科人群中并不常见。其表现可能为影像学检查时偶然发现的无症状病变、腹部肿块、腹痛或尿路感染。通过临床和放射学检查很难区分囊性病变的良性和恶性病因。由于担心将恶性肿瘤升级，不建议进行粗针活检。只有在手术后通过组织病理学才能确诊。根据某些影像学特征，可以怀疑其为良性，从而考虑采取保守的手术方法以保留肾脏。在对这些患者进行保留肾单位手术（NSS）时，冰冻切片活检有助于排除恶性肿瘤。NSS可通过开放手术或微创手术进行。在组织学确诊为囊性肾瘤后，无需其他辅助治疗，但强烈建议进行长期监测。
