A multi-septated mystery: Diagnosis and management of renal cystic nephroma

Cystic nephroma is a rare benign renal tumor often challenging to distinguish preoperatively from malignant cystic renal masses. We present a 46-year-old female with incidental detection of a left renal multilocular cystic mass classified as Bosniak IV on imaging during staging for breast carcinoma. Due to suspicion of malignancy and proximity to renal vessels, laparoscopic radical nephrectomy was performed. Histopathology confirmed adult cystic nephroma. Postoperative follow-up showed no recurrence. This case underscores the diagnostic complexity of cystic nephroma and highlights the importance of comprehensive radiological and pathological evaluation to guide management, promoting nephron-sparing surgery whenever feasible to preserve renal function.