Unanticipated papillary renal cell carcinoma in a complicated renal cyst: A case of radical nephrectomy following surgical complications

Cystic renal masses are often presumed benign, especially Bosniak I or IIF lesions. Rarely, papillary renal cell carcinoma (PRCC) can arise within these cysts, posing diagnostic and surgical challenges. We report a 40-year-old male with a right renal cyst under surveillance for three years as Bosniak IIF. Progressive growth led to laparoscopic cyst unroofing, but intraoperative findings of a solid mass and significant bleeding necessitated urgent radical nephrectomy. Histopathology confirmed pT2bN0Mx PRCC with solid and pseudopapillary features. This case underscores imaging limitations, the potential for malignancy in low-risk cysts, and the importance of vigilant monitoring, preoperative planning, and patient counseling.