Renal Cell Cancer

Bosniak classification of benign renal cysts.

we are beginning to catch renal cell carcinoma before it is symptomatic - blood, flank pain, hematuria, hypertension by that time patient is stage 4

stage 1 is empty no septa or solid component 0 % cancer. 

stage 2 0% cancer, few thin septa, minimal enhancement

2F 5 % cancer, multiphases, multiple thin septa, enhnacements.

III thickened wall thick half solid 50% cancer

4 multiphases multiphases 95% cancer

Bosniak I 

• Well-defined, thin (≤ 2 mm) smooth wall; homogeneous simple fluid (- 9 to 20 HU); no septa or calcifications; the wall may enhance
  
  

Bosniak II

Six types, all well-defined with thin (≤ 2 mm) smooth walls:

1. Cystic masses with thin (≤ 2 mm) and few (1–3) septa; septa and wall may enhance; may have calcification of any type
   
2. Homogeneous hyperattenuating (≥ 70 HU) masses at non-contrast CT
3. Homogeneous non-enhancing masses > 20 HU at renal mass protocol CT. May have calcification of any type
4. Homogeneous masses -9 to 20 HU at non-contrast CT
5. Homogeneous masses 21 to 30 HU at portal venous phase CT
6. Homogeneous low-attenuation masses that are too small to characterize