Investigation of cystic formations of the kidney, adrenal glands (PG060)

Cystic formations of the kidney and adrenal glands — is a pathomorphological study of the walls and contents of the cavity structures removed from the kidneys or adrenal glands. Code PG060 involves a thorough analysis of the material to differentiate between simple (benign) cysts and cystic forms of cancer. Since imaging methods (CT/MRI) cannot always unequivocally exclude malignancy, histological verification is a mandatory step after surgical intervention.

Research objective: The main task is to determine the nature of the cyst and exclude malignancy. In the kidneys, this is important for diagnosing the cystic variant of renal cell carcinoma, and in the adrenal glands, for differentiating between functional cysts, adenomas with cystic degeneration, and rare forms of adrenal cancer.

What does the pathologist evaluate:

• Inner lining type: analysis of the cells lining the cavity (flattened, cuboidal, or atypical epithelium).

• Complex wall structure: search for solid (dense) components, septa, or foci of calcification (calcinosis).

• Signs of malignancy: detection of cellular atypia or invasion into the surrounding renal parenchyma or adrenal tissue.

• Cyst contents: analysis for the presence of decay products, hemorrhages, or specific cellular elements.

• Condition of surrounding tissues: assessment of healthy parenchyma on the border with cystic formation.

Cystic formations of the adrenal glands under code PG060 are also checked for signs of hormonal activity (if morphologically possible) and for the presence of pheochromocytoma or adrenocortical carcinoma cells, which may have a cystic component.

Clinical significance: For the surgeon and oncologist, the PG060 result is crucial in determining further tactics. If a simple cyst is confirmed (e.g. Bosniak I-II), the patient does not require further treatment. Detection of signs of cancer in the cyst wall requires staging and development of a plan for systemic therapy or enhanced monitoring.

When is it prescribed:

• after removal of complex kidney cysts (Bosniak III and IV);

• in the surgical treatment of large adrenal cysts (more than 4-5 cm);

• with rapid growth of cystic formation according to ultrasound or CT scan;

• in the event of the appearance of a solid (tissue) component inside a previously diagnosed cyst.