Dr. Khant Shahil Ramesh Bhai
Urology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 37 year old male. About three weeks ago, I had an abdominal CT due to severe stomach pain. The CT revealed a possible 1.1 inch mass in my left kidney. I had a follow-up ultrasound that showed 1.5 inch thing in the central part of the left kidney. They were unsure whether it was a mass or a hypertrophied column of Bertin due to being located in the central part of the kidney. I followed up with a urologist who believed a nephrectomy was likely. My significant risk is obesity, and I do not have a history of smoking. Is this more likely to be a pseudotumor? I am hoping the MRI gets a clear look but, could that even lead to a false positive? I just want the information needed to ask my doctor questions following the MRI. I do not want to end up losing a kidney if there is a possibility that the mass is not really there.
Hello,
Welcome to icliniq.com.
CT scan with contrast should be able to differentiate between both. If it is still not able to differentiate, then go for an MRI. If MRI is also not conclusive, then go for a percutaneous biopsy. A percutaneous biopsy will definitely differentiate between both. Then you can take the call accordingly.
Thanks.
Patient's Query
Hi doctor,
Thank you for replying. I have attached the ultrasound, CT scan, and urine test report. The doctor's impression when he read the scans was that I would need a complete nephrectomy of the left kidney, but was using the MRI as more of a way to decide whether they could salvage any part of the kidney. It seemed that he had already made up his mind that nephrectomy was likely. The doctor said the reason why the imaging was poor was that the mass was near the main blood vessel in the kidney. The radiologist reports attached do not seem to suggest anything that drastic. I want to make sure the doctor is not already biased in removing the kidney prior to seeing the MRI results, which is being conducted tomorrow. I will upload the MRI results when I get them. Please let me know what you think.
Hello,
Welcome back to icliniq.com.
I have seen all reports, CT, and ultrasound films provided by you (attachment removed to protect patient identity). Your case is not straight forward. After seeing the CT images, I think there are 20 percent chances of this lesion could be benign and 80 percent chances of it being malignant. For benign lesion, you do not require nephrectomy, but for a malignant lesion, nephrectomy is the treatment of choice. At present, go ahead with the MRI scan, and let the MRI reports come. If that is unequivocally suggestive of malignancy, then you will require nephrectomy. If that is equivocal, then I think you can insist your doctor for a CT-guided biopsy, though it has its risk. If it is malignant on biopsy, then nephrectomy is the only option.
Thanks.
Patient's Query
Hello doctor,
Thank you for replying. I have attached the radiologist report from my MRI. I do not have the images, so I am hoping you can make sense of this report. I spoke with the physician's assistant at my doctor's office, and the surgeon already had me down for a date next month. She was not giving me solid answers to whether it is likely malignant or not. I will have a follow-up appointment prior to the surgery date. Does the collected information suggest the mass needs to be removed? Is it malignant or not? Please let me know what you think.
Hello,
Welcome back to icliniq.com.
I have seen the MRI report sent by you (attachment removed to protect patient identity). Looking at the MRI report, there are features which suggest towards malignancy. First, it is a complex cyst, which has more chances of malignancy. There is also nodular and cystic enhancement, which suggest it to be malignant. After looking at the MRI, I think you should go ahead with the nephrectomy. Nephrectomy could be partial or complete. Partial is difficult as it is situated near pelvis and surrounding vessels which supply kidney. But the choice is with your doctor, whether to do partial or complete nephrectomy. You can still have an opinion of another urologist in your town if you want. But looking at the reports, I think you should go ahead with nephrectomy. If possible, send the MRI images. And do let me know what your final decision is.
Thanks.
Patient's Query
Thank you doctor,
I went ahead with a partial nephrectomy. The tumor was removed and measured 1.18 inch, the margins were good. I have attached the pathology report that I got today. The tumor was listed as pT1a and Fuhrman grade 2. All the doctors say the prognosis is very good. There will be routine follow-ups for at least the next five years. Is the Fuhrman grade 2 cause more concern even though the mass is still fairly small? Do I have a much greater chance of reoccurrence? I could not find any reliable information that correlated the tumor size with Fuhrman grade at level 2. Any insight you can provide will be great.
Hello,
Welcome back to icliniq.com.
Nice to hear from you. So, it was a good decision to remove your renal mass. Regarding pathology, I want to know about the type of tumor, is it clear cell, papillary, etc.? The size of 1.18 inch and negative margins suggest a good prognosis. Fuhrman grade 2 is a low-grade tumor. There are 4 Fuhrman grades, and grade 3 and 4 are high grades. So at present, there is nothing to worry. The chances of recurrence are minimum, possibly say 2 to 4 percent. Thanks.
Patient's Query
Hello doctor,
Thanks so much for your response. Forgot to put that it is a clear cell tumor. This confirms what everyone has been telling me about the low rate of reoccurrence. It was a good decision. The surgery ended up taking almost five hours given the tumor's location, but I also walked away with about 1.6 functioning kidneys instead of only one kidney. Thanks for your advice earlier. It helped make the decision much easier to go ahead with the surgery. I will reach out to you, should I have anymore questions.
Hello,
Welcome back to icliniq.com.
Yes, clear cell tumor has a good prognosis, so do not worry. Thanks for your kind words. I am available anytime you want my help. Thanks.
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Urology
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