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Tumor recurrence, four tumors connected with root tissue. Should I go for partial neph or radial neph?

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I am seeking your opinion regarding my hard case, tumor recurrence . I am 28 years old male.try to smrize
Feb09: incidental finding by CT, Renal Tumor and Liver Tumor, Liver Tumor confirmed to be Focal Nodular Hyperplasia(FNH)
Mar09: Open surgery, Partial Nephrectomy removed tumor. Histopathology confirmed it was OncoCytoma with clear margins. Surgery performed in King XXXXXXX Specialty Hospital, one of the best hospitals in Saudi. Ultra sound and CT performed every 6-7 months.
Mar11: CT normal findings, FNH same size, No growth in Kidney.
Jan12: CT & MRI, Multi-Focal tumors in the same kidney(left side), starting on the same location as the previous tumor(upper Pole)! The 4 tumors are connected with the same root tissue & are located along the surf of the upper pole. No other tumors in the abdomen and chest area. FNH same size
Radiologists recommend radcal neph. Interventionist “refused” and did not recommend doing a biopsy. XXXXXXX it is very critical and will not change treatment option.

Visited many Urologists (my mother is Dr). XXXXXXX this is very very rare case.Some recommend Partial others Radical neph. All suggested this was very aggressive behavior. Recommended to test fresh slides (from old tumor) to double check. Tests performed last week on the fresh slides. histopathology conforms Oncocyt with NO RCC cells. They say the current tumor might be Oncocytosis which can have RCC hybrid.
I have 2 options
1-Radical Nep, open surgery, same hospital next week
2-Partial nep, Robotic surgery, in Ohio Clevland, after 3 weeks.

1)what are your thoughts regarding options? Can I wait for 3 weeks? Shall I go with partial or radical?
2)How common is Oncocytoma recurrence? Is this suggesting RCC or oncosytosis?
3)Where can this metastasize to?
4)If I go for radical, how that change quality of life? What if this occurs in the other kidney later?
5)Do I have to do brain/testicular CT?
6)Anything important to consider?

Posted Thu, 19 Apr 2012 in Cancer
Answered by Dr. Indranil Ghosh 1 hour later

I have gone through the history provided by you. Oncocytoma is a benign phenomenon and is usually cured by resection. Recurrence, especially multifocal, is indeed a rare phenomenon but unfortunately it has happened in you.

This certainly makes us suspect whether it is oncocytoma. However, oncocytoma is usually associated with chronic kidney disease, which is presumably not there in you. Oncocytoma can also be recurrent and multifocal in hereditary cases, but you have not mentioned about any family history.

Now to answer your questions one by one...

1) What are your thoughts regarding options? Can I wait for 3 weeks? Shall I go with partial or radical?

A. I think both are valid options, in appropriate centres. If cleveland is doing regular robotic surgeries then it should be fine there. Radical is also OK, but if you have a recurrence in the other kidney, then it is a problem. You can wait for 3 weeks. It is unlikely to cause any major problems.

2) How common is Oncocytoma recurrence? Is this suggesting RCC or oncocytosis?

A. As I mentioned earlier, oncocytoma recurrence is rare except hereditary cases. Development of RCC in oncocytoma is even rarer. Oncocytosis can be a possibility but there is no chronic kidney disease.

3) Where can this metastasize to?

A. Metastatic oncocytoma or oncocytosis is almost unheard of.

4) If I go for radical, how that change quality of life? What if this occurs in the other kidney later?

A. Radical nephrectomy by itself will not change the quality of your life. One kidney is sufficient for normal excretion. However, you need to be under close follow-up to detect any possible recurrence in the other kidney. Early detection will facilitate partial nephrectomy.

5) Do I have to do brain/testicular CT?
A. No, I don't think these are indicated.

6) Anything important to consider?
A. I think we have discussed the important things. If you have any other queries, then please feel free to ask me.

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