Options to remove kidney cyst-whole kidney

[canelo]

After an ultrasound to detect a kidney stone, the radiologist detected a cyst (2 cm) on my left kidney. This was follwed by a CT scan and a thin-cut CT scan and a MRI. My urologist scheduled these test to determine if the cyst was a carcinoma: The radiologist report stated:".... The larger lesion on the left kidney which extends exophytically from the cortex, demonstrates high signal intensity roughly equal to fat on the T1-weighted images and decreased signal intensity on inversion recovery images. This lesion becomes nearly isointense with the renal parenchyma on the T2-weighted images. As such, this does not represent a simple cyst. The MRI appearance of this lesion would suggest that it most likely represents a cyst containing proteinaceous or hemorrhagic debris. While I do not see any obvious solid mass associated with the cyst, the possibility that this might represent a partially hemorrhagic cystic renal cell carcinoma can not be excluded". The right kidney appeared normal.

I thought that the MRI could make a positive identification of a carcinoma cyst. is this the case?

My urologist decided to remove the cyst, tested it, and if it was not cancerous, leave my kidney in place, or remove the cyst and kidney if this was a cancerous cyst. Is this the right approach? If the kidney is not removed, can another cyst appear with time?

Are there any other methods of removing the cyst with smaller incisions (laparoscopy??) and is that method effective. Can that method be used to remove the kidney too?

Thanks very much for your help and advise.

[Kevin Pho, MD]

To answer your questions:
1) The MRI sometimes cannot give a definitive diagnosis.  In these case, an image-guided biopsy can be considered and can give the diagnosis in 80 percent of cases.

2) That would seem like a reasonable approach.  It is possible that another cyst may arise in the future if the kidney is left in.

3) If there is questions about what kind of mass is present, and a biopsy is not performed, taking out the whole kidney is considered to decrease the possibility of seeding the peritoneum with any possible cancer.  Yes, it is possible to do a laparaoscopic nephrectomy - you may want to discuss whether this is a consideration in your case.

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[gr1477]

A related discussion, what to do was started.