Cystic necrosis

Introduction Cystic necrosis is mainly caused by kidney cancer. The appearance of the tumor is irregular round or elliptical mass, with a layer of fiber coating; blood supply is rich, vascular anger, hyperemia and hemorrhage. The color of the tumor is related to the number of blood vessels, the lipid content in the cancer cells, and the factors such as hemorrhage and necrosis. Generally speaking, the active growth area is white, the transparent cells are yellow, and the granular cells or undifferentiated cells are grayish white. Dark red or red areas are old or fresh bleeding areas, often cystic changes, central necrosis, hematoma or irregular calcification.

Cause

1 Tumor is cystic growth: Renal cell carcinoma originates from the proximal convoluted tubule epithelial cells, some of which grow in a cystic form, gradually forming multi-atrial masses of varying sizes, with varying amounts of fresh blood in the sac. Tumors often have false envelopes.

2 Kidney cancer center is insufficient for blood supply, and hemorrhage and necrosis form a pseudocyst. The "cyst" is thick and extremely irregular, mostly single room.

3 Kidney cancer originates from the epithelial cells on the wall of the cyst, and the nodules are often located at the base of the cyst.

4 Kidney cancer causes tubules or obstruction of the renal arteries leading to cyst formation. When the cyst enlarges, the tumor is embedded in the cyst, which is rare.

an examination

Related inspection

Kidney MRI examination kidney CT examination synovial fluid routine examination kidney section

The clinical manifestations of cystic renal cell carcinoma are similar to those of renal cancer, as well as gross hematuria, abdominal mass and pain. Since cystic renal cell carcinoma usually has a complete cyst wall, there is less chance of gross hematuria.

Differential diagnosis

The disease should be differentiated from cystic lesions such as kidney abscess, renal cyst, other types of kidney cancer, and polycystic kidney disease.

1 Low-density lesions of renal abscess, enhanced by uniform annular enhancement, abscess wall thickness is uniform, smooth inner wall without wall nodules, cystic contents are free of suspended matter, low-density edema around the lesion, kidney surrounding with infection, kidney The contour is blurred, and it is easier to combine with clinical identification.

2 The typical cyst wall is thin and smooth without enhancement. The identification of water density and cystic renal cell carcinoma is not difficult. However, due to the slow evolution of some complex cysts, regular follow-up of renal cysts is very important. When the cyst wall is thickened or irregular; the wall of the capsule has a solid component and is strengthened; when there is a soft tissue shadow around the cyst, it should be alert to the possibility of malignancy. In addition, careful observation of the internal separation of the cyst, with or without suspended matter, the location of the calcification also contributes to qualitative diagnosis.

3 Ordinary renal clear cell carcinoma with cystic changes due to significant differences in the prognosis of the two, differential diagnosis is particularly important.

4 Multi-atrial cystic nephroma is a hamartoma developed from mesenchymal tissue. The cysts can also be seen in different sizes. The nature of cystic fluid is similar to that of multi-atrial cystic renal cell carcinoma, but its backing The epithelium is a high column or a squamous epithelium with fibroblasts, smooth muscles, and immature interstitial tissue.

5 Adult polycystic kidney disease is often bilateral, the kidney volume is significantly larger, covered with a single layer of flat or cubic epithelium, there is compression and atrophy of the renal parenchyma between the cysts, often accompanied by secondary infection.

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