Renal cystic diseases are common and are often less aggressive and benign in nature. Watchful waiting is the therapeutic choice for managing simple renal cysts. Some malignant tumors of the kidney may have features of a benign renal cyst. It is challenging to determine how to manage such affections of the kidney. Very few of these cases have been reported in the literature but do not have a standard therapeutic approach. The objective of this case presentation is to discuss useful ways in

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... ng renal cancer presenting as a renal cyst. Case presentation: A 78-year-old moroccan male farmer with no significant medical history presented with a 2 year intermittent left flank pain. Physical examination was unremarkable. Ultrasound and computed tomography (CT) scan found multiple simple renal cysts including one suspected renal cyst. A radical nephrectomy was performed. Anatomopathological studies of the specimen confirmed a renal cancer. Conclusion: We emphasize on the importance of thorough imaging studies for cystic affections of the kidney as the least feature of malignancy should be considered in its therapeutic management. We recommend surgery as a justified therapeutic approach in managing cystic renal lesions when there is a suspicion of malignancy.