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Urology (Expert Forum)
Kidney cyst
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Kidney cyst
by zoner, Jun 04, 2003 12:00AM
I am a 75 yr. old male in fairly good health, with a kidney mass which was scanned on 6/27/02 and again recently on 5/6/03 to check for interval growth.
The radiologysts report states: Interval change in exophytic left renal mass, denser than a cyst. Its AP dimension has increased to 4.5 cm from 4.0 cm. The mass is otherwise unchanged without evidence of enhancement. A punctate mural calcification is noted unchanged.
Question: How do I proceed now?
1. Do nothing now and have another scan in a year?
2. Have a needle biopsy now?
3. Surgically remove the cyst now?
4. Since I am 75 yrs old ---- forget about it?
Doctor's Answer
by Kevin Pho, MD, Jun 05, 2003 12:00AM
, Jun 05, 2003 12:00AM
Hello - thanks for asking your question.
With a kidney mass, you want to differentiate between a cyst and something more serious such as cancer or an abscess. This should be able to be done by a CT scan, but if the CT scan is indeterminate, then an MRI can be performed.
Findings suggestive of possible malignancy and therefore of the clear need for removal include diameter above 3 cm, poor margins, and areas of necrosis suggestive of rapid growth.
Preoperative needle biopsies are generally not recommended for resectable renal lesions because of concern about seeding of the peritoneum. However, in patients with indeterminate imaging studies, percutaneous image-guided biopsy appears to be safe and may provide a diagnosis in up to 80 percent of cases.
So, to answer your question, it seems that it may be prudent to remove the cyst or the kidney containing the cyst, solely based on the size and its rate of enlargement. However, the total picture, including your surgical risk, needs to be taken into account and this should be discussed with your urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Rose. Simple renal cysts and evaluation of a renal mass in adults. UptoDate, 2003.
With a kidney mass, you want to differentiate between a cyst and something more serious such as cancer or an abscess. This should be able to be done by a CT scan, but if the CT scan is indeterminate, then an MRI can be performed.
Findings suggestive of possible malignancy and therefore of the clear need for removal include diameter above 3 cm, poor margins, and areas of necrosis suggestive of rapid growth.
Preoperative needle biopsies are generally not recommended for resectable renal lesions because of concern about seeding of the peritoneum. However, in patients with indeterminate imaging studies, percutaneous image-guided biopsy appears to be safe and may provide a diagnosis in up to 80 percent of cases.
So, to answer your question, it seems that it may be prudent to remove the cyst or the kidney containing the cyst, solely based on the size and its rate of enlargement. However, the total picture, including your surgical risk, needs to be taken into account and this should be discussed with your urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Rose. Simple renal cysts and evaluation of a renal mass in adults. UptoDate, 2003.
Thank You
William, age 56