Is a cystic mass in the kidney with perfusion of the rim indicative of renal cell carcinoma?

Q. A 44-year-old female has a cystic mass in the kidney with perfusion of the rim. Is it RCC?

Answered by
Dr. Samer Sameer Juma Ali Altawil
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 06, 2021 and last reviewed on: Aug 07, 2023

Hi doctor,

A 44-year-old female and has no symptoms. The incidental finding on CT is a small renal mass. Ultrasound with contrast finding is the lesion within the left kidney. It is well defined with fundamental imaging. The lesion measures approx 0.70 inch and has solid appearances on baseline examination. The lesion is hyperechoic compared to the surrounding cortex. Contrast-enhanced imaging demonstrates perfusion of the rim of the lesion but very little in terms of perfusion of the internal component. Appearances on contrast-enhanced imaging may be that of a thick-walled cyst, but, given the appearances of the baseline examinations, suspicion of a cystic renal cell carcinoma remain high. The rest of the kidney is normal. All blood tests normal except for low iron and slightly high platelets. Heavy periods, suspected for anemia. The following are current medications Fluoxetine, Levothyroxine, Ramipril, and Iron tablet. Please comment on recommended treatment.



Welcome to

0.70 inch cystic mass in the left kidney. The cyst which enhances on CT (computed tomography) scan is likely to be renal carcinoma with the precision of 90 percent as it is classified as type four renal cyst. The size is small, and the best treatment for you, in my opinion, is to remove it as you are still young. There are centers to do enucleation of the cyst by robotic and some with laparoscopic surgery. I do it with open and with ultrasound guidance if required. There are other less invasive methods like radiofrequency ablation or cryotherapy. I think removal by robotic surgery, if available, is best. If not, then laparoscopic or open. I advise cryotherapy or ablation for older patients who are not fit for surgery or with a short lifespan. If you have any more queries, please do not hesitate to ask. I hope this was helpful.

Hi doctor,

Thank you.

What features make this type four? How long is tumor enucleation surgery done laparoscopically? What is the mortality rate? What are the most common complications? How long is the recovery time? Is not it unusual to have RCC at age 44 in a non-smoker female? Kindly give your opinion.



Welcome back to

Type four is enhancing means there is blood perfusion in it. The time usually depends on the procedure and surgeon. It is about two to three hours. Open surgery is faster, about an hour to one and a half hours. The mortality rate is less than one percent for a fit patient. The most common complication is a urinary leak, but adequate surgery and superficial tumor leak chances are low. Other complications are bleeding and conversion from laparoscopic to open. The recovery time is about three to four days, after which the patient can go home. Risk factors for RCC (renal cell carcinoma) are hypertension, obesity, and genetic, in addition to smoking. It can happen even earlier than 44 years. Please keep me updated about your condition. I hope this was helpful.

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