Results of CT Scan

[Totie]

Can you tell me what this means?

Findings:  1.9 x 2.5 x1.7 cm mass within the midline just anterior to the L5, S1 disk space. It is felt to be retoperitoneal, predominantly of fatty attenuation, but has a calfified rim. There are faint internal septations, but no nodular soft tissue density components. It is a solitary lesion and there is no additinoal evidence that would suggest adenopathy.

Impression: Retroperitoneal mass is in the midline with fatty density. Should be of concern for a teratoma. However, the appreance is really quite unusual for a teratoma given that the calcifications are circumferential and rim like. It is possible the patient had a lipoma with infarction. Low density, but calcified lymph nodes can be seen in various granulomatous diseases. Does the patient have a history of prior histoplasmosis? Nonetheless, I do believe that this lesion should at least be followed if not sampled in order to ensure benignity.

My regular doctor told me we could not biopsy because of location, and does not think it is causing any of my problems. She will follow up on it in 3 months.

Symptoms:  weight loss, insomnia, swollen lymph nodes of the neck (under jaw line), extreme upper thigh pain, constant urination, night sweats.

Is this something to worry about?

[Totie]

My doctor finally re did the CT Scan of the mass.I had to do it with barrium and contrast this time. She said it was a granuloma. I do not believe it grew in size, i am going to request copies of my records. Right now the only thing she has done is ordered a 24 hr urine test and more blood work. She does not think it is cancerous, but then again she said it could be the answer to all my health problems for the last two years. A biopsy was not mentioned and I don't go back to her until July 30. I was put on antibiotics for an infection of the lymph node uner my jaw line by the ENT. The neck scan revealed only lymph nodes, but should not be the cause of my problems.

My health insurance does not allow me to go to anyone else, or any other specialist without a referral from her.

Thank you ....

[Charles Rosen, MD]

Dear Totie,

I don’t believe, with all due respect to your regular doctor, that you should just watch it.  You have symptoms that sound fairly severe, and a mass.  I suggest you see a general surgeon, preferably a surgical oncologist for an evaluation, and perhaps an infectious disease specialist if this is possibly an old infection (granuloma).  Also, I would be somewhat surprised if an interventional radiologist cannot do a CT guided needle biopsy. In any case, I believe you need to find out what this is before you get any sicker than you already are.

Dr. Rosen

Charles Rosen, MD
Clinical Professor of Orthopaedic Surgery
Spine Surgery
University of California, Irvine, College of Medicine
Founding Director, UCI Spine Center  
Orange, California