Multilocular cystic renal cell carcinoma (MCRCC) is a relatively are cystic tumor of the kidney. Because of its distinct characteristics in prognosis and natural history, MCRCC was recognized as a separate subtype of renal cell carcinoma in the 2004 WHO classification of adult kidney tumors.1We report two cases of MCRCC, one from antemortem surgical specimen and the other from the post mortem (autopsy) which was an incidental finding of smallest size which is a rare occurrence and probably the first reported case. Introduction Multilocular cystic RCC is a distinct subtype of clear-cell RCC and appears to have a favorable biology. These tumors are a rare entity, comprising approximately 1 to 2% of all renal tumors. 2 We report two cases of MCRCC, one from antemortem surgical specimen and the other from the post mortem (autopsy) which was an incidental finding of smallest size which is a rare occurrence. To the best our knowledge, this is probably the first reported case. Case History Case 1: A 55-year-old male presented with left flank pain and hematuria since 2 months. Ultrasound revealed a mass in upper pole of the left kidney. A left nephrectomy was carried out. Grossly, the specimen measured 18 × 10 × 10 cms which included the tumor of 9 cms diameter which was well circumscribed and encapsulated. The renal capsule was grossly free. The cut section was multiloculated, cystic. The cysts ranged from 2 mm to 2 cm. The content of the cyst included clots and gelatinous material. Microscopically, the section showed a multicystic tumor. The cysts were separated by fibrocollagenous connective tissue lined by clear cells. The clear cells had small hyperchromatic nuclei with mild anisonucleosis and inconspicuous nucleoli. Renal capsule, vessels, and perinephric fat were free. The histomorphology was compatible with multilocular cystic renal cell carcinoma, Fuhrman nuclear grade I. After 2 years follow up, the patient is well with no recurrences.Figure 1A: Gross of kidney mass showing cystic tumor with multiloculations and no solid foci seen.Figure 1B: Microscopy of the cytic mass showing cysts lined by clear cells. Inset(c) shows high power of the cyst lined by clear cells.
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