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Done With CAT Scan And Ultrasound. Taking Testosterone. Ultrasound Showing Second Kidney Tumour. What Does The Report Indicate?

Posted on Wed, 13 Nov 2013

Question: I need a radiologist or a urologist that will download my catscans and Ultrasound, 4 of them from 2013 throughout the year and will compare the size of the kidney tumor back in January that was about 8cm, and then after I used Testosterone, two ultrasounds showed a second kidney tumor at 4.5cm in Aug and then 5cm in Sept. However I Started a new therapy and in just one month, the Oct. cat scan showed only the initial tumor at 8.7cm. I need to know if the ultrasounds that detected this second tumor could be wrong possibly. I have a nephrectomy scheduled but If my therapy is working, I want to postpone. I hold no one responsible but myself. I have had this renal cell carcinoma since I was 26 (45yrs now) first measured at 3.5 and shrunk therafter down to 1.1cm. I stopped my therapy for a few years eating sugar, pain killers, adderral (at night in order to work..about 40$ a night) and the next thing I knew I urinated huge clots and streams of blood. Cat scan showed tumor doubled in size to 7cm back in 2011. I refused radical nephrectomy in order to go back to alternative therapy and immune therapy. This may take a couple of hours to FTP to the place I have the scans uploaded. You need a PC to view the scans. Mac will not work. You must be familiar with ftp in order to download the additional info
I really need someone that can read both ultrasounds and catscans...

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer:
Probably one tumor, please send ftp link

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail and seen attached reports.

In my opinion, after having seen the CAT scan dated 09 October 2013, there was initial confusion about a second tumor in ultrasound reports, which is possibly wrong. AS CAT scan is more detailed, the tumor has grown to a size to involve the renal pelvis and possible extending into the proximal right ureter. There is no mention of second tumor in CAT scan report and I feel the necrotic component was probably seen and mentioned as a second lesion in ultrasound reports.

Well, we can wait for a while to solve the single tumor/ twin tumor confusion until you send me the ftp link. I am familiar with ftp and have worked in a cancer hospital for 3 years doing cancer radiology.

Waiting for an update from your end.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (1 hour later)

I am aware of what you intelligently just explained however, the second tumor was described as being in the middle of the kidney while the original is at the upper pole I have other ultrasounds from just last year not mentioning this Second one I started an aggressive alternative therapy just 6 or 7 weeks ago so although it is highly improbable, I want to know for sure the website is WWW.WWWW.WW with an ftpuser name babsiev and password being SUCCESS321!

Answered by Dr. Vivek Chail (5 hours later)

Brief Answer:
Can't locate ftp link on WWW.WWWW.WW
Detailed Answer:
Hi XXXX,

Thanks for writing in with an update.

I am sorry to say that though I went to website WWW.WWWW.WW as mentioned by you, I could not find any ftp link on the website.

Please guide me further on that.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (15 hours later)

You just have to open up an FTP program such as cute FTP or file zilla and then put the website in first like this WWW.WWWW.WW and then the user and pass. Therte is no link for me to send you. I thought I responded to you in detail this morngin but I obviously never pressed submit as I was on my phone. I have blood when i take too many pain killers. small clots...

Answered by Dr. Vivek Chail (53 minutes later)

Brief Answer:
Technical error login

Detailed Answer:
Hi XXXX,
Thanks for your update on required ftp details.

I am sorry to state that there is login error on both cute ftp and filezilla.

Cute FTP gives the following messages:

COMMAND:>     [15-10-2013 08:21:29] USER babsiev
          [15-10-2013 08:21:29] 331 User babsiev OK. Password required
COMMAND:>     [15-10-2013 08:21:29] PASS *****
          [15-10-2013 08:21:30] 530 Login authentication failed
ERROR:>      [15-10-2013 08:21:30] Not logged in.
COMMAND:>     [15-10-2013 08:21:35] USER babsiev
          [15-10-2013 08:21:36] 331 User babsiev OK. Password required
COMMAND:>     [15-10-2013 08:21:36] PASS *****
          [15-10-2013 08:21:36] 530 Login authentication failed
ERROR:>      [15-10-2013 08:21:36] Not logged in.
STATUS:>      [15-10-2013 08:21:39] Connection closed.

File Zilla gives following messages:

Status:     Resolving address of WWW.WWWW.WW Status:     Connecting to 72.167.227.99:21...
Status:     Connection established, waiting for welcome message...
Response:     220---------- Welcome to Pure-FTPd [privsep] [TLS] ----------
Response:     220-You are user number 11 of 500 allowed.
Response:     220-Local time is now 19:30. Server port: 21.
Response:     220-This is a private system - No anonymous login
Response:     220 You will be disconnected after 3 minutes of inactivity.
Command:     USER babsiev
Response:     331 User babsiev OK. Password required
Command:     PASS ***********
Response:     530 Login authentication failed
Error:     Critical error
Error:     Could not connect to server
Status:     Resolving address of WWW.WWWW.WW Status:     Connecting to 72.167.227.99:21...
Status:     Connection established, waiting for welcome message...
Response:     220---------- Welcome to Pure-FTPd [privsep] [TLS] ----------
Response:     220-You are user number 12 of 500 allowed.
Response:     220-Local time is now 19:30. Server port: 21.
Response:     220-This is a private system - No anonymous login
Response:     220 You will be disconnected after 3 minutes of inactivity.
Command:     USER babsiev
Response:     331 User babsiev OK. Password required
Command:     PASS **********
Response:     530 Login authentication failed
Error:     Critical error
Error:     Could not connect to server

Most other patients of mine send me JPG or DICOM format images through Dropbox. Is it possible for you to please do the same.

I am eagerly waiting to have a look at your images to resolve the two lesion paradox. Passing of blood in urine is something that needs immediate medical attention.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (3 days later)

This user name and pass has to work.

bvale
Success321!

Thank you for your patience and I know time is money so I will add some extra money with a bonus for making you waste time with a wrong password....
The blood was tremendous last year in March. Because I have had this tumor since 1994 and had it under control with apricot seeds and immunotherapy, I chose to try again. The problem is that 7cm is the size that renal cell carcinomas can start spreading. It has grown since last year but may have stopped. My operation is scheduled for Nov. 6 and regardless if the original tumor has shrunk or not, it is time to get this out of my body. I want to know however, if that second tumor which was reported in two ultra sounds could have been a mistake or if it truly has disappeared and had actually been there for the months of Aug and sept...Thank you for your help. I do not have many drs. considering I have been out of the conventional loop for many many years, depending only on some scans for diagnose and drs. only to get scrips for scans over the years....

XXXX

Answered by Dr. Vivek Chail (6 hours later)

Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

I have been able to see your CT scan images. Your symptoms are explained by the size and location of the tumor. In my opinion, there is no second tumor in the renal pelvis but the upper pole tumor which has a smaller component below measuring 4.8 cms. There is no clear cut interface between two areas. Therefore the second one that is seen on ultrasound has not disappeared but it is a part of the bigger lesion. It is solid in consistency and not the necrosis component, which is seen separately.

The tumor is still confined to the boundaries of kidney and therefore the surgeon can take out the tumor in its entirety.

Hope your query is answered.
Should you have any doubts, please write back.

Best wishes for the surgery.
Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (2 days later)

The ultra sound shows a second tumor have you looked at the ultrasound to if it is possible for two radiologist on two separate ultrasounds one Month apart was read I correctly I also supplied you w an ultrasound from last November for comparisons what is your understanding of the necrotic part. Is that possibly from dying off, or the tumor being so big that the middle has no blood supply or what else. also it appears u are suggesting that just the tumor can be removed but it is my understanding that the whole kidney must come out.. The second tumor is vascular so it is not an incorrect reflection of the center necrotic part as u said

Answered by Dr. Vivek Chail (6 hours later)

Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

Ultrasound is an operator dependent test and findings also depend on area being visualized. The appearances in ultrasound may show two smaller tumors when there is a single large one. So in my opinion from CT images alone is that there is what I believe to be a larger tumor with two components. It might be possible that even if I were to do the ultrasound, I would interpret it as two smaller tumors.

The necrotic part is the center of the tumor which is dying due to limited or absent blood supply. You are right in saying that “the tumor being so big that the middle has no blood supply”.

May I clarify that I meant the tumor is well confined to the kidney margins and not locally spread to the surrounding organs. That way it is the right time to operate on you and that the entire kidney is taken out. I am NOT suggesting that just the tumor be removed.

I re confirm that the apparent second tumor is not necrotic and has got good blood supply which means it has the possibility of further growing in size.

Hope your query is answered.
Should you have any doubts, please write back.

Best wishes for the surgery.
Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (15 hours later)

I do not understand your response the reports said that there were two passage tumors one at 8.5cmand the other at 4.5 cm I the Seco d ultra sound test a MO th later a different operator took pictures of the same two tumors at 9cm ans 5cm the radiologist reporting growth of both the ultrasound I sent u from a year ealier shows one tumor so the fact that two operators saw two tumors thst were large shoots down the last theory proposed respectfully my question lies unanswered I need someone to read the ultrasounds ans Compare them to the cat scan and tell me if it looks like a mistake or a possibility of a second tumor at one point I am asking this because I started an Intense alternative therapy nor the month between the last ultrasound ans thr last cat scan so I want to know if that alternative therapy possibly what's the cause for this mysterious second tumor to have disappeared

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer:
Please find clarifications below

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

I would like to make certain clarifications with regards to my earlier response.

1. The ultrasound reports done in August and September 2013, both suggest presence of two different tumors 8-9 cms and 4-5 cms. The report documents are signed by the same individual, the doctor mentioned in the reports appears to be the same (Dr XXXXXXX Ham, MD). So the image interpretation was most likely done by the same individual and therefore operator bias might have a role here. May I request you to please guide me on that issue.

2. I am unable to find any tumor details in the ultrasound report dated 2012 (page 7 of the pdf attached). The page 2/2 of ultrasound report done in November 2012 the report is missing. This appears to be causing communication gap between us as to how the tumor looked like a year back. I am completely unaware of how the tumor appeared a year back.

3. I have seen the CAT scan images and find that the second tumor detailed in ultrasound reports dated August and September 2013 is persistent. However, the CAT scan report mentions it as a part of the larger tumor which is extending below and involving the renal pelvis. Going by these findings and comparisons, the so called second tumor in ultrasound reports is still seen on the CAT scan images.

Hope I have been able to clarify on your query.
Please do write back should you seek further clarifications.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (44 minutes later)

so in your opinion there was never a second tumor. And this is based on the renal pelvis being involved in both the ultra cat scan. I am assuming the renal pelvis is more toward the middle of the kidney.....

I don't think last years cat scan is necessary...

Answered by Dr. Vivek Chail (12 hours later)

Brief Answer:
Never a second tumor in my opinion

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update

In my opinion there was never a second tumor as your have pointed out. The renal pelvis is located in the middle portion of the kidney and allows the passage of formed urine into the ureters through it. Therefore any tumor element involving the renal pelvis may cause obstruction to the flow of urine from the kidney into the bladder through the ureters. This can then lead to obstructive changes in the kidney and also cause bleeding can occur in urine.

Hope I have been able to answer your query.
Please do write back if you have any doubts.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar