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What Does An Ultrasound Showing A Lobulated Hyperechoic Lesion Indicate?
Question: Hi Dr., I'm a 66 year old white male. 2-1/2 years ago I was diagnosed with RCC and had a successful radical nephrectomy. All has gone well, with negative CT scans every 6 months. However yesterday my ultrasound showed a lobulated hyperechoic lesion. Is this serious? Is it at all related to my previous diagnosis of RCC? Thank you for your answer.
Brief Answer:
Hi and welcome to HCM
Detailed Answer:
Well, first, I dont think there is a reason for concern. This is not usual feature of rcc relaps and if there was radical nephrectomy then this could indicate postoperative fibrosis or cyst formation which are benign lesions. However, caution is necessary and frequent follow ups. if there will be rapid growth of lesion or some malignant features appear,then biopsy is required. I dont think that ultrasound could be more sensitive than ct. So consult your dr about performing CT next time, not us. It will reveal more morphologic lesions of this lesion. WIsh you good health. Regards
Hi and welcome to HCM
Detailed Answer:
Well, first, I dont think there is a reason for concern. This is not usual feature of rcc relaps and if there was radical nephrectomy then this could indicate postoperative fibrosis or cyst formation which are benign lesions. However, caution is necessary and frequent follow ups. if there will be rapid growth of lesion or some malignant features appear,then biopsy is required. I dont think that ultrasound could be more sensitive than ct. So consult your dr about performing CT next time, not us. It will reveal more morphologic lesions of this lesion. WIsh you good health. Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Romic.
Thank you very much for your timely reply. You sound rather optimistic about my diagnosis. Here are some more specific comments about my liver from my recent ultrasound report for your information:
"There is a lobulated lesion measuring 3.1 X 3.9 X 2.6 cm in the right hepatic lobe with internal vascularity. There is an additional hyperechoic 0.8 cm round lesion seen near the hepatorenal space that is new compared to the prior examination (CT scan done 12/03/2013). ... This may represent a hemangioma."
The report also notes: "The spleen is (mildly) enlarged measuring 13.4 X 4.6 X 4.4 cm. No mass is identified."
Does this give you any more insight into my diagnosis? Any reason for concern before I return to my urologist September 2, 2014?
Thank you very much again!
Thank you very much for your timely reply. You sound rather optimistic about my diagnosis. Here are some more specific comments about my liver from my recent ultrasound report for your information:
"There is a lobulated lesion measuring 3.1 X 3.9 X 2.6 cm in the right hepatic lobe with internal vascularity. There is an additional hyperechoic 0.8 cm round lesion seen near the hepatorenal space that is new compared to the prior examination (CT scan done 12/03/2013). ... This may represent a hemangioma."
The report also notes: "The spleen is (mildly) enlarged measuring 13.4 X 4.6 X 4.4 cm. No mass is identified."
Does this give you any more insight into my diagnosis? Any reason for concern before I return to my urologist September 2, 2014?
Thank you very much again!
Brief Answer:
hi
Detailed Answer:
it would be easier for me if you could show ct images. but considering your description, I still think this is lobulated liver cyst or hemangioma. RCC rarely metastasis after 2 year(but it is not impossible). Of course, this could be primary liver tumor or secondary due to some other cancer not related to rcc. This radiologic finding is nonspecific and nothing can be ruled out, but there would be some other radiologoic features and symptomatology if it represents metastases. Liver biopsy in these cases is not recommended until there is high suspicious of malignancy or ct cant reveal exact diagnosis. YOu need ct follow up and evaluate growth of these lesions. if natures of these lesion still cant be determined, you should do MRI.
hi
Detailed Answer:
it would be easier for me if you could show ct images. but considering your description, I still think this is lobulated liver cyst or hemangioma. RCC rarely metastasis after 2 year(but it is not impossible). Of course, this could be primary liver tumor or secondary due to some other cancer not related to rcc. This radiologic finding is nonspecific and nothing can be ruled out, but there would be some other radiologoic features and symptomatology if it represents metastases. Liver biopsy in these cases is not recommended until there is high suspicious of malignancy or ct cant reveal exact diagnosis. YOu need ct follow up and evaluate growth of these lesions. if natures of these lesion still cant be determined, you should do MRI.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Romic,
Thanks again for your comments concerning my liver results on my recent ultrasound. Lastly, I'd like your diagnosis on other organs scanned at that time:
CBD: (Stable) large gallstone measuring up to 2.9 cm. No pericholecystic fluid or wall thickening is present.
Right kidney (left radical nephectomy 12/1/11): Measures 12.5 cm in length and there is a 2.1 cm inferior pole cyst.
Spleen: Enlarged measuring 13.4 x 4.6 x 4.4 cm. No mass is indicated.
Should I be concerned? I feel fine, and have no pain anywhere. Do you believe there is any connection of the above results to my kidney cancer diagnosis?
Thanking you kindly!
Thanks again for your comments concerning my liver results on my recent ultrasound. Lastly, I'd like your diagnosis on other organs scanned at that time:
CBD: (Stable) large gallstone measuring up to 2.9 cm. No pericholecystic fluid or wall thickening is present.
Right kidney (left radical nephectomy 12/1/11): Measures 12.5 cm in length and there is a 2.1 cm inferior pole cyst.
Spleen: Enlarged measuring 13.4 x 4.6 x 4.4 cm. No mass is indicated.
Should I be concerned? I feel fine, and have no pain anywhere. Do you believe there is any connection of the above results to my kidney cancer diagnosis?
Thanking you kindly!
Brief Answer:
Hi
Detailed Answer:
This is significant gallstone size and it may cause symptoms in future so if you will have gallbaldder attacks,you should do cholecystectomy.
Kidney is bit enlarged but this is normal since the other kidney enlarged when one is removed due to compensation. This cyst is probably just simple renal cyst and it should be just followed up by ultrasound every 6 months,there is no need for specific measures.
Enlargemen of spllen can be caused by various causes and sometimes it is seen in healthy people. this is moderately enlarged spleen and it is hard to say the exact cause. it can be any infection in our body, some liver disorders or some heamtologic disorders. If your WBC and liver markers are fine then you dont have to be cocnerned about your spleen finding.
Soo all in all, I doubt that previous kidney cancer is related to your ct finding. Of course RCC is serious disease and it is considerd that you are cured only if 5 years with no relaps has passed. But it is good that 2.5 years already passed and that there wasnt metastases at the time of rcc diagnosis.
Most commonly it spreads to lymph nodes, lung and bones. Bit less common to liver and brain and very rarely to spleen or other places.
I still dont see prove of relpas,but frequent follow up is neccesary and it would be advisable to do PET-CT scan in future. WIsh you good health.
Hi
Detailed Answer:
This is significant gallstone size and it may cause symptoms in future so if you will have gallbaldder attacks,you should do cholecystectomy.
Kidney is bit enlarged but this is normal since the other kidney enlarged when one is removed due to compensation. This cyst is probably just simple renal cyst and it should be just followed up by ultrasound every 6 months,there is no need for specific measures.
Enlargemen of spllen can be caused by various causes and sometimes it is seen in healthy people. this is moderately enlarged spleen and it is hard to say the exact cause. it can be any infection in our body, some liver disorders or some heamtologic disorders. If your WBC and liver markers are fine then you dont have to be cocnerned about your spleen finding.
Soo all in all, I doubt that previous kidney cancer is related to your ct finding. Of course RCC is serious disease and it is considerd that you are cured only if 5 years with no relaps has passed. But it is good that 2.5 years already passed and that there wasnt metastases at the time of rcc diagnosis.
Most commonly it spreads to lymph nodes, lung and bones. Bit less common to liver and brain and very rarely to spleen or other places.
I still dont see prove of relpas,but frequent follow up is neccesary and it would be advisable to do PET-CT scan in future. WIsh you good health.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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