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ADPKD Renal Cell Carcinoma — ESENeph MCQ

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HardPolycystic Kidney DiseaseADPKD Renal Cell CarcinomaESENeph

A 65-year-old man with ADPKD and eGFR 15 mL/min/1.73m2 develops severe, constant flank pain. CT shows a complex cyst with thick septations and enhancing mural nodule (Bosniak IV). What is the most important consideration?

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Correct answer: B — Renal cell carcinoma – requires urological evaluation

Bosniak IV cysts (thick irregular septations, enhancing solid components) have a >90% malignancy rate. ADPKD patients have an increased risk of renal cell carcinoma, and a Bosniak IV lesion requires urgent urological referral for consideration of nephrectomy. Differentiating complex cysts from malignancy in ADPKD is challenging due to the background of multiple cysts. MRI can help characterise, but Bosniak IV is considered malignant until proven otherwise.

Reference: EAU 2024 – Renal Tumour Guidelines; Bosniak Classification 2019 Update