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What Does My Test Report Indicate?
Question: Hi, I was wondering if this report is good news? and what it means.
CASE: SAH-14-008559
PATIENT: XXXXXXX VESELIK
SPECIMEN:
1. HEPATIC FLEXURE POLYPS
2. SIGMOID COLON POLYP
CLINICAL INFORMATION:
Specimen collected on 12/4/2014 9:30:00 AM.
Screening.
ICD-9: 569.9, unspecified disorder of intestine
PATHOLOGIC DIAGNOSIS:
1,2. HEPATIC FLEXURE AND SIGMOID COLON POLYPS: TUBULAR ADENOMAS.
MICROSCOPIC DESCRIPTION:
1,2. The sections show portions of polypoid colonic mucosa with crypts lined by
stratified epithelial cells with elongated hyperchromatic nuclei, decreased
numbers of goblet cells and an increased mitotic rate. The lamina propria
contains an increased number of chronic inflammatory cells. There is no evidence
of high grade dysplasia or malignancy.
GROSS DESCRIPTION:
1. The specimen consists of many fragments of polypoid soft XXXXXXX mucosa measuring
in aggregate 0.8 cc. Entirely submitted.
2. The specimen consists of 3 irregular pieces of soft XXXXXXX tissue ranging in
size from 0.1 to 0.3 cm in greatest dimension. En
tirely submitted. GB/lmk
CASE: SAH-14-008559
PATIENT: XXXXXXX VESELIK
SPECIMEN:
1. HEPATIC FLEXURE POLYPS
2. SIGMOID COLON POLYP
CLINICAL INFORMATION:
Specimen collected on 12/4/2014 9:30:00 AM.
Screening.
ICD-9: 569.9, unspecified disorder of intestine
PATHOLOGIC DIAGNOSIS:
1,2. HEPATIC FLEXURE AND SIGMOID COLON POLYPS: TUBULAR ADENOMAS.
MICROSCOPIC DESCRIPTION:
1,2. The sections show portions of polypoid colonic mucosa with crypts lined by
stratified epithelial cells with elongated hyperchromatic nuclei, decreased
numbers of goblet cells and an increased mitotic rate. The lamina propria
contains an increased number of chronic inflammatory cells. There is no evidence
of high grade dysplasia or malignancy.
GROSS DESCRIPTION:
1. The specimen consists of many fragments of polypoid soft XXXXXXX mucosa measuring
in aggregate 0.8 cc. Entirely submitted.
2. The specimen consists of 3 irregular pieces of soft XXXXXXX tissue ranging in
size from 0.1 to 0.3 cm in greatest dimension. En
tirely submitted. GB/lmk
Brief Answer:
Bad News- Colonic polyps are present, Good News- They are benign
Detailed Answer:
Hi, thanks for posting the concern in the HCM.
From the report, it is evident that adenomatous polyps are present in hepatic flexure and sigmoid colon.
Adenomatous polyps can be of different types and whether they are dangerous or not (means they would progress to cancer or not) depends on the presence of villous component in them.
Fortunately enough, you have got tubular adenomatous polyps. So, chances of malignancy (progress to develop cancer) are typically less. More good news is that, on microscopic examination no dysplastic or malignant changes were found (no cancer is present), but mitotic rate is high (adversely affects prognosis).
So, above is all about the report. If you want to know about polyps, I would say they are mucosal lesions. They project into the gut lumen and there are different types. Accordingly, prognosis is also different. I have mentioned what is there in your case and put some light on the prognosis.
Now, what is needed for the time-being is that you need to urgently consult a local surgeon or preferably a specialist in gastrosurgery. I don't think any surgical intervention is urgently needed. But, regular follow up under a surgeon's supervision is must so that any further worsening or any chance of malignancy can be detected at the earliest. God forbids, if there is any sign of malignancy that can be taken care of if detected at an early stage. Then, resection of the affected part would be needed.
Hope, you have now understood what you have got and what to do. If you have any further query, you may right back. If you are satisfied with the answer, you can close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Bad News- Colonic polyps are present, Good News- They are benign
Detailed Answer:
Hi, thanks for posting the concern in the HCM.
From the report, it is evident that adenomatous polyps are present in hepatic flexure and sigmoid colon.
Adenomatous polyps can be of different types and whether they are dangerous or not (means they would progress to cancer or not) depends on the presence of villous component in them.
Fortunately enough, you have got tubular adenomatous polyps. So, chances of malignancy (progress to develop cancer) are typically less. More good news is that, on microscopic examination no dysplastic or malignant changes were found (no cancer is present), but mitotic rate is high (adversely affects prognosis).
So, above is all about the report. If you want to know about polyps, I would say they are mucosal lesions. They project into the gut lumen and there are different types. Accordingly, prognosis is also different. I have mentioned what is there in your case and put some light on the prognosis.
Now, what is needed for the time-being is that you need to urgently consult a local surgeon or preferably a specialist in gastrosurgery. I don't think any surgical intervention is urgently needed. But, regular follow up under a surgeon's supervision is must so that any further worsening or any chance of malignancy can be detected at the earliest. God forbids, if there is any sign of malignancy that can be taken care of if detected at an early stage. Then, resection of the affected part would be needed.
Hope, you have now understood what you have got and what to do. If you have any further query, you may right back. If you are satisfied with the answer, you can close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you for the quick response. I also have lesions in my kidneys. Could these be connected to the development of the polyps? I will give you the results of my recent ultra sound. How often should I have these polyps checked?
Here are the results from my recent ultrasound:
Patient Name: VESELIK, XXXXXXX XXXXXXX
Patient MRN: 821761 Account #: 0000 DOB: 08/24/1961
Facility: ASH
Date of Exam: 11/19/2014 Occurrence #: 0000 DocID: 175904
Ordering Provider: XXXXXXX XXXXXXX
Report: US RENAL
Report Dictated By: XXXXXXX Bloomgarden, MD, Radiologist
CC: XXXXXXX XXXXXXX
Renal ultrasound
Location code 4
History: Renal mass. Followup.
Technique: Grayscale and color Doppler imaging performed of both kidneys and bladder.
Findings: Comparison made with ultrasound from August 2013 and CT scan from October 2013.
The right kidney measures 10.6 cm in length. There is normal cortical thickness and echogenicity.
Within the right kidney medially is a hypoechoic lesion with echogenic focus within it, centrally. It measures 1.8 x 1.4 x 1.2 cm. Previously measured 1.2 x 1.0 x 0.8 cm. No other masses, stones, or hydronephrosis is noted.
The left kidney measures 12.6 cm in length. There is normal cortical thickness and echogenicity. Within the periphery of the left cortex, posteriorly there is 1.6 x 1.5 x 1.4 cm lesion that measures 1.7 x x 1.6 x 1.2 cm previously. Differences are likely
related to measuring error. Also, there is a somewhat echogenic rim and is not completely anechoic. Through transmission is present.
The bladder is normal with bilateral ureteral jets.
Impression: Enlarging medial lesion with echogenic centers, possible calcification, within it. This is not a simple cyst by ultrasound and could be a solid lesion or cystic malignancy. Consider multiphase imaging with CT or MRI for further
characterization.
Lesion within the left kidney is stable in size, but also shows some worrisome feature with echogenic periphery. Attention to this area on followup imaging.
Here are the results from my recent ultrasound:
Patient Name: VESELIK, XXXXXXX XXXXXXX
Patient MRN: 821761 Account #: 0000 DOB: 08/24/1961
Facility: ASH
Date of Exam: 11/19/2014 Occurrence #: 0000 DocID: 175904
Ordering Provider: XXXXXXX XXXXXXX
Report: US RENAL
Report Dictated By: XXXXXXX Bloomgarden, MD, Radiologist
CC: XXXXXXX XXXXXXX
Renal ultrasound
Location code 4
History: Renal mass. Followup.
Technique: Grayscale and color Doppler imaging performed of both kidneys and bladder.
Findings: Comparison made with ultrasound from August 2013 and CT scan from October 2013.
The right kidney measures 10.6 cm in length. There is normal cortical thickness and echogenicity.
Within the right kidney medially is a hypoechoic lesion with echogenic focus within it, centrally. It measures 1.8 x 1.4 x 1.2 cm. Previously measured 1.2 x 1.0 x 0.8 cm. No other masses, stones, or hydronephrosis is noted.
The left kidney measures 12.6 cm in length. There is normal cortical thickness and echogenicity. Within the periphery of the left cortex, posteriorly there is 1.6 x 1.5 x 1.4 cm lesion that measures 1.7 x x 1.6 x 1.2 cm previously. Differences are likely
related to measuring error. Also, there is a somewhat echogenic rim and is not completely anechoic. Through transmission is present.
The bladder is normal with bilateral ureteral jets.
Impression: Enlarging medial lesion with echogenic centers, possible calcification, within it. This is not a simple cyst by ultrasound and could be a solid lesion or cystic malignancy. Consider multiphase imaging with CT or MRI for further
characterization.
Lesion within the left kidney is stable in size, but also shows some worrisome feature with echogenic periphery. Attention to this area on followup imaging.
Brief Answer:
Further evaluation of renal lesion and follow up for colonic polyp needed
Detailed Answer:
Hi, thanks for the reply.
I will answer your queries one after another.
Regarding the result of imaging, the lesion in your kidneys need further evaluation. According to the reports, malignancy must first be excluded. A CT scan of abdomen is needed. If necessary biopsy may be done. Although the mass doesnot have the classical hypoechoic halo, the appearance is not completely normal. Furthermore, the solid mass is a matter of further concern.
CT scan definitely helps in diagnosing and staging malignancy, if any. But, MRI is superior to CT in giving some information regarding histology.
Therefore, please consult your treating doctor regarding further imaging.
Regarding your query regarding follow up for polyps, ideally colonoscopy at every 3 years interval will be needed. But, in case of low-risk adenomatous polyps, gastroenterologists now often recommend follow up colonoscopy at 5 years interval. Therefore, you need to consult your treating doctor regarding follow up advice. My understanding is follow up at 3 years interval is preferable.
Now, regarding relationship between renal lesion and colonic polyps, I don't think one can spread to the other site or if at all there is any renal malignancy, they would give rise to such polyps as metastatic lesions. But, your renal masses definitely need urgent and detailed evaluation to rule out cancer.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Further evaluation of renal lesion and follow up for colonic polyp needed
Detailed Answer:
Hi, thanks for the reply.
I will answer your queries one after another.
Regarding the result of imaging, the lesion in your kidneys need further evaluation. According to the reports, malignancy must first be excluded. A CT scan of abdomen is needed. If necessary biopsy may be done. Although the mass doesnot have the classical hypoechoic halo, the appearance is not completely normal. Furthermore, the solid mass is a matter of further concern.
CT scan definitely helps in diagnosing and staging malignancy, if any. But, MRI is superior to CT in giving some information regarding histology.
Therefore, please consult your treating doctor regarding further imaging.
Regarding your query regarding follow up for polyps, ideally colonoscopy at every 3 years interval will be needed. But, in case of low-risk adenomatous polyps, gastroenterologists now often recommend follow up colonoscopy at 5 years interval. Therefore, you need to consult your treating doctor regarding follow up advice. My understanding is follow up at 3 years interval is preferable.
Now, regarding relationship between renal lesion and colonic polyps, I don't think one can spread to the other site or if at all there is any renal malignancy, they would give rise to such polyps as metastatic lesions. But, your renal masses definitely need urgent and detailed evaluation to rule out cancer.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you very much for taking the time to answer all of my questions. I see my Primary doctor on Wednesday. I am going to be praying very very hard that this is not cancer. I am very scared!
Brief Answer:
Don't worry and hope for the best
Detailed Answer:
Hi, please don't worry. With early diagnosis and treatment, most of the diseases, even cancers, can be managed well. Hope for the best and get all the required tests done at the earliest without undue delay. Please comply to treatment and I hope everything will be OK. Please let me know about any further progress in the diagnosis. You are always welcome for any query.
If you find my answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Don't worry and hope for the best
Detailed Answer:
Hi, please don't worry. With early diagnosis and treatment, most of the diseases, even cancers, can be managed well. Hope for the best and get all the required tests done at the earliest without undue delay. Please comply to treatment and I hope everything will be OK. Please let me know about any further progress in the diagnosis. You are always welcome for any query.
If you find my answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you. I will let you know what my Doctor says at my appointment on Wednesday.
Thank you XXXXXXX Veselik
Thank you XXXXXXX Veselik
Brief Answer:
Welcome
Detailed Answer:
Hi XXXXXXX thanks for your reply. I will be waiting for your reply after you visit your doctor's clinic. Please write back anytime if you have any query.
If you find my answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Welcome
Detailed Answer:
Hi XXXXXXX thanks for your reply. I will be waiting for your reply after you visit your doctor's clinic. Please write back anytime if you have any query.
If you find my answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hi Dr. Sarkar, I had my appointment today. My doctor is getting me set up for a CT Scan. He told me that the CT Scan is more definitive, because they can see the mass from different angles. He also told me that there were a few things in the blood and urine test that he had me get. He said there was no blood in my urine which is good news, because kidney cancer would leave blood in the urine. He also said that the blood test for kidney function was very much in the very good range. We also talked about the colonoscopy results. He and the GI doctor both agree that I should have another colonoscopy in a year. He said the polyp they removed was precancerous, but displayed fast growing cells so they didn't want to wait 3-5 years and give another one a chance to develop and become cancerous. Do you agree with this?
Thank you XXXXXXX Veselik
Thank you XXXXXXX Veselik
Brief Answer:
A better understanding is needed.
Detailed Answer:
Hi, thanks for posting the concern in HCM.
You have mentioned here some diagnosis and treatment related decisions inferred by your doctor's and want to know whether they are rational.
Firstly, your doctor has correctly said that you need a CT scan. It is the primary investigation now which is needed for you to rule out any malignancy in the kidney. If any malignancy is present, CT will also help in staging. As I have said earlier, MRI will be more helpful to find out theparticular cell and tissue type involved and vascularity. In other words, I don't contradict what your doctors said.
Secondly, your doctor was also correct regarding the statement that absence of blood in urine is a good sign. But, that doesn't altogether rule out malignancy in kidney. So, you can definitely hope for the best, but further investigations for confirmation are needed.
Third, imaging alone cannot explain everything. Rather, blood and urine investigations are also needed to come to a specific diagnosis.
Fourth, I have said that your colonic polyps are not malignant. But, they can give rise to malignancy in future. So, they are precancerous. Now, as I had said, a problem in your polyps are that they have increased mitotic activity. I had mentioned the generalised protocol for follow up, but since they are precancerous, your doctor are also right about it - to remove a lesion before it transforms into a cancer. And your doctors are doing that rightly. If they think that you are a high risk patient, what you actually are, and should be followed up yearly, they are not wrong in their view.
I think now you can understand that views are actually unanimous. If you find this answer helpful, please close the thread and rate my answer.
Regards
Dr Kaushik Sarkar
A better understanding is needed.
Detailed Answer:
Hi, thanks for posting the concern in HCM.
You have mentioned here some diagnosis and treatment related decisions inferred by your doctor's and want to know whether they are rational.
Firstly, your doctor has correctly said that you need a CT scan. It is the primary investigation now which is needed for you to rule out any malignancy in the kidney. If any malignancy is present, CT will also help in staging. As I have said earlier, MRI will be more helpful to find out theparticular cell and tissue type involved and vascularity. In other words, I don't contradict what your doctors said.
Secondly, your doctor was also correct regarding the statement that absence of blood in urine is a good sign. But, that doesn't altogether rule out malignancy in kidney. So, you can definitely hope for the best, but further investigations for confirmation are needed.
Third, imaging alone cannot explain everything. Rather, blood and urine investigations are also needed to come to a specific diagnosis.
Fourth, I have said that your colonic polyps are not malignant. But, they can give rise to malignancy in future. So, they are precancerous. Now, as I had said, a problem in your polyps are that they have increased mitotic activity. I had mentioned the generalised protocol for follow up, but since they are precancerous, your doctor are also right about it - to remove a lesion before it transforms into a cancer. And your doctors are doing that rightly. If they think that you are a high risk patient, what you actually are, and should be followed up yearly, they are not wrong in their view.
I think now you can understand that views are actually unanimous. If you find this answer helpful, please close the thread and rate my answer.
Regards
Dr Kaushik Sarkar
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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