Bosniak Cyst/Renal Cyst/Kidney Cyst: Risk of Cancer or Not

Hello Friends!

Hope you are getting benefits from my previous posts. Today we will discuss about Bosniak Cyst. Around 20 million people have Chronic Kidney disease where patients experience a gradual deterioration of Kidney function, the end result of which is Kidney Failure. Healthy eating plays an important role in reducing risk of getting CKD (Chronic Kidney Disease). “Go Green, have more fiber to prevent Kidney Failure”. Let’s discuss about Bosniak Cyst and we will understand the relation between Bosniak and Renal Cyst.

Cyst:

Cyst is a Membranous Sac or Cavity of abnormal character in the body containing fluid. Cysts are filled with liquid, semisolid and gaseous material. Cysts occur within tissue and can affect any part of the body. Cysts vary in size. The outer portion of a Cyst is called Cyst Wall. If the Sac is filled with Pus it is not a Cyst, it is an Abscess.

Bosniak Cyst:

Bosniak Cyst is classification system of Renal Cystic Masses. It is named after Morton A Bosniak who was Professor in Radiology Department at New York University, Langone School of Medicine. The Bosniak classification for Renal Cysts was developed in late 1980s for management of complex Cystic Renal Lesions. Bosniak classification system has also been utilized with some advantages for magnetic resonance imaging.

Relation between Bosniak Cyst and Renal Cyst:

A Renal Cyst is a fluid collection in a Kidney. There are several types of Renal Cysts on basis of Bosniak classification. Majority of Cysts are Benign and some are Cancerous and are removed by surgical procedure called Nephrectomy. Many Renal Cysts are seen in Cystic Kidney Diseases which include Polycystic Kidney Disease and Medullary Sponge Kidney.

Bosniak Classification System:

Renal Cysts are classified into 5 groups:

1. Bosniak Type I Cyst:

(a) It is a simple Cyst.

(b) These Cysts are located in Renal Cortex.

(d) No Septa, Calcification's or Solid components are found in these Cysts.

(e) These are simple Cysts with a hair line thin wall, water attenuation and no enhancement.

(f) The Malignant or Cancerous chance in these Cysts is 0%.

(g) Size of Cyst: 5-10mm in diameter.

2. Bosniak Type II Cyst:

(a) Bosniak Type II Cyst is minimally complicated.

(b) This Cyst has thin Septa (less than 1mm) with hair line in which no measureable enhancement may be appreciated.

(d) High attenuation: Uniform in Lesions (less than 3cm) that are sharply marginated and don’t enhance.

(e) Surgical approach is not mandatory in Bosniak Type II Cyst.

(f) 0% chance for Cancer with this Cyst.

3. Bosniak Type II-F Cyst (F means Follow):

(a) Septa: Multiple hair line thin in which no measurable enhancement of Septum or wall is appreciated.

(b) Minimal thickening of Septa(less than 25% of wall visible) or Septa may contain calcification. It can be thick, nodular but no measurable contrast enhancement.

(d) Intra-Renal: Renal Lesions (>3cm). It is mainly hyper dense Cyst mostly intra-renal.

(e) Bosniak Type II-F Cyst suggests a slight risk of Malignant Cancer.

(f) The chances of Cancer with this Cyst are 5%.

(g) This Cyst requires follow up, needs Ultrasound/CT scan/MRI.

4. Bosniak Type III Cyst:

(a) Measurable enhancement is present with Cystic mass, thickened irregular or smooth walls or multiple Septa.

(b) These Cysts can be multiple in natures.

(d) 55% chances of Malignant Cancer with this Cyst.

(e) Multiple Septa (>1mm) without an intra cystic nodular lesion.

(f) Treatment: Partial Nephrectomy or Radio Frequency Ablation in elderly or poor surgical candidates.

5. Bosniak Type IV Cyst:

(a) Enhancing soft tissue components.

(b) Clearly Malignant Cystic Masses.

(d) Solid mass with a large Cystic or a Necrotic component.

(e) 100% Malignant Cancer.

(f) Treatment: Partial or Total Nephrectomy.

Note: Ablation Therapy is a type of Minimally Invasive procedure Doctor’s used to destroy abnormal tissue that occurs in Kidney.

Causes of Bosniak Cyst/Renal Cyst/Kidney Cyst:

1. It is not clear what causes Bosniak, Renal or Kidney Cysts. According to one theory Bosniak or Renal Cysts develop when the surface layer of kidney weakens and forms a pouch that is Diverticulum. The pouch then fills with fluid, detaches and develops into a Cyst.

2. Other cause of Bosniak, Renal or Kidney Cysts can be inherited disease called PKD (Polycystic Kidney Disease). PKD is a genetic disorder characterized by clusters of cysts that can impair kidney function.

Symptoms of PKD:

- High Blood Pressure.

- Pain in back and side.

- Blood in urine.

- Frequent Kidney Infections.

Symptoms of Bosniak Cyst/Kidney Cyst/Renal Cyst:

These Cysts are common in old aged people. Typically they don’t cause any symptoms. Rare symptoms may include:

1. Fever due to infections.

2. Pain or Tenderness between Ribs and Pelvis.

3. Upper Abdominal Pain.

4. Changes in urinary habits.

5. Blood in the Urine (Hematuria) or dark urine.

6. Dull pain in back or side.

Tests to diagnose Bosniak/Renal or Kidney Cysts:

1. Abdominal and Pelvic Ultrasound: These ultrasounds are performed to take pictures of Kidneys and confirm the presence of fluid inside the Renal Cysts.

2. Abdominal and Pelvic CT scan: CT scan helps to distinguish Benign Cysts from Tumors in the Kidneys. CT scan is done by using contrast material.

3. MRI: MRI uses a magnetic field and radio frequency pulses to produce detailed pictures of kidneys. In MRI also contrast material is injected in the vein.

4. CT Enterography (latest technique): CT enterography uses special X-ray equipment and an injection of contrast materials after the ingestion of liquid to produce detailed images of structures within abdomen and pelvis. CT images provide greater detail than traditional X-rays particularly of soft tissues and blood vessels.

5. ACR Test: ACR is Albumin to Creatinine ratio. Albuminuria is presence of albumin in urine and a marker of kidney damage. ACR is first method of preference to detect elevated protein, measuring urinary ACR in a spot urine sample.

Normal ACR range - 30 to 300mg/g.

6. GFR Test: GFR Test is Glomerular Filtration Rate. GFR is a blood test to measure how much blood your kidneys filter each minute.

Normal Range for GFR in Men= 100-130 mL/min/1.73m²

Normal Range for GFR in women= 90-120 mL/min/1.73m²

7. Serum Creatinine: Creatinine ia a waste product and is present at higher level in blood of people with kidney dysfunction.

Treatment for Bosniak/Renal/Kidney Cysts:

Renal Cysts generally don’t require treatment unless they are causing harm to kidney function like blocking blood flow or urine flow.

1. Sclerotherapy: It is also known as Percutaneous Alcohol Ablation. Sclerotherapy involves insertion of a long needle through the skin and into the cyst under ultrasound guidance. The doctor will drain the cyst and fill it with an alcohol based solution that causes the tissue to harden and shrink, reducing the chance of recurrence. The procedure is usually performed with local anesthesia.

2. Surgery: For larger Cysts, a surgeon will make a small incision and access the cyst with a laparoscope. The surgeon will drain the cyst and burn or cut away its outer layer. Laparoscope surgery requires general anesthesia.

Who are at higher risk of Bosniak/Renal/Kidney Cysts?

1. Age factor older than 50 years.

2. More common among men.

3. Renal dysfunction.

4. Hypertension: Hypertension cause renal dysfunction which results in Renal Cysts.

5. Smokers.

6. Inherited Cystic Kidney Disease.

7. Cardiovascular disease.

(Also Read: Heart Attack).

8. Presence of protein in urine (PKD2 Protein).

9. Diabetic Patients.

Complications due to Bosniak/Renal/Kidney Cysts:

1. Infection in the Cyst.

2. Burst Cyst.

3. Blockage of urine out of kidney.

4. High blood pressure.

5. Kidney failure by age 60.

When to see a Doctor?

If you feel any of the following symptoms:

1. Vomiting.

2. Severe pain.

3. Fever or chills.

4. Visible blood in urine.

5. Nausea.

6. Loss of Appetite.

7. Fatigue or Weakness.

8. Sleep problems.

9. Shortness of breath.

Foods to avoid during Bosniak/Renal/Kidney Cysts:

1. Avoid high potassium enriched food.

2. Bananas.

3. Salty Foods.

4. Fast Foods.

5. Processed Meat.

6. Bran and whole grains.

7. Most dairy products.

8. Potatoes.

9. Nuts.

10. Spinach.

11. Tomatoes.

12. Cantaloupe.

13. Vegetable Juice.

Natural Remedies:

1. Low Potassium foods.

2. Apples.

3. Blackberries, Blueberries, Strawberries and Raspberries.

4. Broccoli.

(Also Read:10 Best Foods to Improve Eyesight/Vision)

5. Carrots.

6. Kale.

7. Cabbage.

8. Cucumbers.

9. Watermelon.

10. Citrus fruits like oranges, pineapple.

“Kidney is a silent organ but ignoring it can lead to disastrous consequences”.

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Bosniak Cyst/Renal Cyst/Kidney Cyst: Risk of Cancer or Not