Is surgery needed for hyperechoic kidney lesion?

Question

Hi doctor,

A 44-year-old female has no symptoms. The incidental finding on CT is a small renal mass. Ultrasound with contrast finding shows a lesion within the left kidney. It is well defined with fundamental imaging. The lesion measures approximately 0.70 inches and has a solid appearance on baseline examination. The lesion is hyperechoic compared to the surrounding cortex. Contrast-enhanced imaging demonstrates perfusion of the rim of the lesion but very little in terms of perfusion of the internal component. Appearances on contrast-enhanced imaging may be that of a thick-walled cyst, but, given the appearances of the baseline examinations, suspicion of a cystic renal cell carcinoma remains high. The rest of the kidney is normal. All blood tests are normal except for low iron and slightly high platelets. Heavy periods, suspected for anemia. The following are current medications: Fluoxetine, Levothyroxine, Ramipril, and an Iron tablet. Please comment on the recommended treatment.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

A 0.70-inch cystic mass in the left kidney (attachment removed to protect the patient's identity). The cyst, which enhances on a CT (computed tomography) scan, is likely to be renal carcinoma with a precision of 90 percent, as it is classified as a type four renal cyst. The size is small, and the best treatment for you, in my opinion, is to remove it as you are still young. There are centers to do enucleation of the cyst by robotic and some with laparoscopic surgery. I do it with open and with ultrasound guidance if required. There are other less invasive methods like radiofrequency ablation or cryotherapy. I think removal by robotic surgery, if available, is best. If not, then laparoscopic or open. I advise cryotherapy or ablation for older patients who are not fit for surgery or have a short lifespan.

I hope this was helpful. If you have any more queries, please do not hesitate to ask.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Type four is an enhancing means that there is blood perfusion in it. The time usually depends on the procedure and the surgeon. It is about two to three hours. Open surgery is faster, about an hour to one and a half hours. The mortality rate is less than one percent for a fit patient. The most common complication is a urinary leak, but the chances of adequate surgery and superficial tumor leak are low. Other complications are bleeding and conversion from laparoscopic to open. The recovery time is about three to four days, after which the patient can go home. Risk factors for RCC (renal cell carcinoma) are hypertension, obesity, and genetic factors, in addition to smoking. It can happen even earlier than 44 years. Please keep me updated about your condition.

I hope this was helpful.

Thank you.