Sep 19, 2012 - 2:02 pm
To Jeff, in particular:- your thoughts on the following would be appreciated - interpretation, significance, follow-up etc. and, in particular what types of scan, or other investigation you think might be sensible.
Right nephrectomy for high grade sarcomatoid T4 renal cell carcinoma. Level 4 follow-up. Single met at first post op CT (3/12) - 1cm. Removed at surgery 4 weeks later measured at 2.5 cm. Histopathologically complete excision. Seroma only at initial CT follow-up. Close follow-up (Level 4) : FOR EARLY SEPTEMBER 2012 PLEASE
CT Thorax & abdo & pelvis with contrast:
Chest: The lungs are clear apart from chronic scarring at the bases. No lymphadenopathy in the chest.
Abdomen and pelvis : Liver, spleen, pancreas and remaining solitary left kidney remain free of metastatic disease.
The previously noted fluid collection at the site of the right nephrectomy is no longer demonstrated although there is some residual soft tissue thickening present. However, there is now a further encapsulated fluid collection with peripheral enhancement, measuring approximately 2.5 cm. x 1.8cm. , lying within the right anterolateral abdominal wall just adjacent to the anterior and inferior aspect of the liver, close to the gallbladder. In retrospect, this was visible before but was indeed hardly measurable.
The retroperitoneal lymphadenopathy has slightly increased with a necrotic appearing aortocaval node measuring at least 1.5 cm. In short axis diameter. Although this may be reactive, metastatic involvement cannot be entirely excluded.
No other evidence of any convincing metastatic disease.
Opinion: Increase In size of a fluid collection in the anterolateral right abdominal wall (differential diagnosis necrotic metastatic lesion) and retroperitoneal lymphadenopathy.