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What Can New Hetergeneous Soft Tissue Density Mean In The

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Posted on Thu, 25 Jul 2019
Question: what can new hetergeneous soft tissue density mean in the region of pancreas tail resection which is abutting the kidney. Does that mean it either scar tissue or a tumor on the tail of pancreas. Thank you. it measures 2.6 x 2.3 x 2.2cm. Thank you
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Follow up: Dr. Vivek Chail (0 minute later)
what can new hetergeneous soft tissue density mean in the region of pancreas tail resection which is abutting the kidney. Does that mean it either scar tissue or a tumor on the tail of pancreas. Thank you. it measures 2.6 x 2.3 x 2.2cm. Thank you
doctor
Answered by Dr. Vivek Chail (6 hours later)
Brief Answer:
Less likely scar and tumour needs to be ruled out by detailed scans and biopsy if indicated.

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

Heterogeneous soft tissue in the pancreas is a non specific finding and can be visualized in many conditions. It is less likely scar tissue unless any previous surgery is done in the area and causing fat stranding.

It might represent a tumour but this needs to be confirmed by a contrast CT or MRI scan and a biopsy if clinically indicated.

Please send in details of the medical condition to enable me to give a more accurate reply.

Regards,


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
Less likely scar and tumour needs to be ruled out by detailed scans and biopsy if indicated.

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

Heterogeneous soft tissue in the pancreas is a non specific finding and can be visualized in many conditions. It is less likely scar tissue unless any previous surgery is done in the area and causing fat stranding.

It might represent a tumour but this needs to be confirmed by a contrast CT or MRI scan and a biopsy if clinically indicated.

Please send in details of the medical condition to enable me to give a more accurate reply.

Regards,


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Vivek Chail (7 hours later)
He underwent a common bile duct resection, portal lymphadenectomy and distal pancreatectomy with splenectomy on 10/18/2017.

Pathology: 3.7 cm poorly differentiated adenocarcinoma invading beyond the wall of the bile duct. 0 of 9 nodes had metastatic adenocarcinoma. The proximal margin was focally positive. His distal pancreatectomy demonstrated a 1.8 cm invasive adenocarcinoma with 2 of 6 lymph nodes positive. The margins were negative.

Cat scan was taken on 3/29/2019. Will attach for you to review. Also cat can takes on 6/10/2019.

cat scan on 3/29/2019 indicated new heterogeneous soft tissue density mean in the region of pancreas tail resection which is abutting the kidney. measures 2.6 x 2.3 x 2.2cm.

Surgeon did not know what this image was. He told him, it is mostly likly scar tissue, but he did not perform any other scan to determine exactly what is was.

A pet scan should of been done with a cat scan. Combined cat scan/pet scan.

if I am correct, the pet scan would of determined what the image was that measured 2.6 by 2.3 x 2.2 cm. (A tumor or scar tissue)

As you can see by cat scan on 6/10/2019, it has spread to other region such as liver and other areas.

Please comment on important of the pet scan. (Meaning would it identify scar tissue or tumor)

Thank you very much
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Follow up: Dr. Vivek Chail (0 minute later)
He underwent a common bile duct resection, portal lymphadenectomy and distal pancreatectomy with splenectomy on 10/18/2017.

Pathology: 3.7 cm poorly differentiated adenocarcinoma invading beyond the wall of the bile duct. 0 of 9 nodes had metastatic adenocarcinoma. The proximal margin was focally positive. His distal pancreatectomy demonstrated a 1.8 cm invasive adenocarcinoma with 2 of 6 lymph nodes positive. The margins were negative.

Cat scan was taken on 3/29/2019. Will attach for you to review. Also cat can takes on 6/10/2019.

cat scan on 3/29/2019 indicated new heterogeneous soft tissue density mean in the region of pancreas tail resection which is abutting the kidney. measures 2.6 x 2.3 x 2.2cm.

Surgeon did not know what this image was. He told him, it is mostly likly scar tissue, but he did not perform any other scan to determine exactly what is was.

A pet scan should of been done with a cat scan. Combined cat scan/pet scan.

if I am correct, the pet scan would of determined what the image was that measured 2.6 by 2.3 x 2.2 cm. (A tumor or scar tissue)

As you can see by cat scan on 6/10/2019, it has spread to other region such as liver and other areas.

Please comment on important of the pet scan. (Meaning would it identify scar tissue or tumor)

Thank you very much
doctor
Answered by Dr. Vivek Chail (26 hours later)
Brief Answer:
PET CT scan will tell us SUV value and is increased in cancer lesions

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

Sorry for the delay in replying.

Cancer of the pancreas is a challenging medical condition and there is always a high risk of recurrent disease even when surgery is done. It is difficult to tell a scar tissue from a recurrent neoplasm by CT scan alone.

Therefore, the best imaging modality is a PET CT scan and this tells us how active or inactive a tissue or mass is and if the activity is of concern for a cancer. In PET CT scan we get to know a variable named SUV or standardised uptake value. The SUV value of the mass can tell us if the metabolic activity in the lesion can be a new cancer in the tail of pancreas.

A high SUV value is almost always a marker for a cancer lesion.

Other than PET CT I can request you to get a blood CA19-9 level and see if it is abnormally increased. This is a marker for pancreas cancer.

Regards,
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
PET CT scan will tell us SUV value and is increased in cancer lesions

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

Sorry for the delay in replying.

Cancer of the pancreas is a challenging medical condition and there is always a high risk of recurrent disease even when surgery is done. It is difficult to tell a scar tissue from a recurrent neoplasm by CT scan alone.

Therefore, the best imaging modality is a PET CT scan and this tells us how active or inactive a tissue or mass is and if the activity is of concern for a cancer. In PET CT scan we get to know a variable named SUV or standardised uptake value. The SUV value of the mass can tell us if the metabolic activity in the lesion can be a new cancer in the tail of pancreas.

A high SUV value is almost always a marker for a cancer lesion.

Other than PET CT I can request you to get a blood CA19-9 level and see if it is abnormally increased. This is a marker for pancreas cancer.

Regards,
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Vivek Chail (2 hours later)
Hi, thank you very much. Why would an Oncologist surgeon with 17 years of experience not do a pet scan as soon as the cat scan came back on 3/29/2019 indicating new heterogeneous soft tissue density in the region of pancreas tail resection which is abutting the kidney. measures 2.6 x 2.3 x 2.2cm.

He told him there is a small spot on the tail of pancreas, and it is probably scar tissue. Told him to come back, and look what happened regarding the second cat scan.

I have a question, for you as a expert, When the tumor was in the pancreas measuring 2.6 cm x 2.3 x 2.2, is that stage 1, now that it has spread to the other areas, is that considered stage 4.

Also if chemo was started when the cat scan showed the 2.6 cm image, would he of had a much better chance of survival instead of being treated not which spread to other area.

You are an excellent doctor. Thank you.
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Follow up: Dr. Vivek Chail (0 minute later)
Hi, thank you very much. Why would an Oncologist surgeon with 17 years of experience not do a pet scan as soon as the cat scan came back on 3/29/2019 indicating new heterogeneous soft tissue density in the region of pancreas tail resection which is abutting the kidney. measures 2.6 x 2.3 x 2.2cm.

He told him there is a small spot on the tail of pancreas, and it is probably scar tissue. Told him to come back, and look what happened regarding the second cat scan.

I have a question, for you as a expert, When the tumor was in the pancreas measuring 2.6 cm x 2.3 x 2.2, is that stage 1, now that it has spread to the other areas, is that considered stage 4.

Also if chemo was started when the cat scan showed the 2.6 cm image, would he of had a much better chance of survival instead of being treated not which spread to other area.

You are an excellent doctor. Thank you.
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Follow up: Dr. Vivek Chail (23 hours later)
Hello Doctor,
Please see this screen capture of an overview of available scans. Please take a look and let me know which would be most useful for you. I have several other folders worth of scans and can send over more overviews for you. Please let me know what you need.
I'm very grateful.
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Follow up: Dr. Vivek Chail (0 minute later)
Hello Doctor,
Please see this screen capture of an overview of available scans. Please take a look and let me know which would be most useful for you. I have several other folders worth of scans and can send over more overviews for you. Please let me know what you need.
I'm very grateful.
doctor
Answered by Dr. Vivek Chail (4 hours later)
Brief Answer:
Chances of survival are not significantly affected due to delay

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

In staging of cancer, a tumour between 2 to 4 mm in measurement without any other spread of cancer is in category stage Ib (American cancer society guidelines).

If a cancer at any time spreads to any other organs it becomes stage IV directly (stages II and III will not apply in this case).

Usually, a suspicion of scar tissue is made if there is a well circumscribed area of tissue. However a possibility of a new or cancer lesion is always to be thought of as a differential diagnosis.

Survival rate in cancer of pancreas depends on many variable can be approximately 20 percent for a one year survival and possibly 5 to 7 percent 5 year survival even with best treatments and when treatment is started before the spread of disease.

A delay of 3 months in starting chemotherapy might cause a probably 2 to 5 percent decreased chances but this is not very clear or significant when we look at the disease process as a whole.

What I mean is, a 3 month delay will not significantly impact the outcome of disease as the cancer cells might have already reached the target organs 3 months back but were too small to be visualised in the scan.

When looking at course of disease above, starting chemotherapy 3 months back might not have significantly changed the course of illness.

I am not able to view any screen shots. May I request you to please add the images again.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
Chances of survival are not significantly affected due to delay

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

In staging of cancer, a tumour between 2 to 4 mm in measurement without any other spread of cancer is in category stage Ib (American cancer society guidelines).

If a cancer at any time spreads to any other organs it becomes stage IV directly (stages II and III will not apply in this case).

Usually, a suspicion of scar tissue is made if there is a well circumscribed area of tissue. However a possibility of a new or cancer lesion is always to be thought of as a differential diagnosis.

Survival rate in cancer of pancreas depends on many variable can be approximately 20 percent for a one year survival and possibly 5 to 7 percent 5 year survival even with best treatments and when treatment is started before the spread of disease.

A delay of 3 months in starting chemotherapy might cause a probably 2 to 5 percent decreased chances but this is not very clear or significant when we look at the disease process as a whole.

What I mean is, a 3 month delay will not significantly impact the outcome of disease as the cancer cells might have already reached the target organs 3 months back but were too small to be visualised in the scan.

When looking at course of disease above, starting chemotherapy 3 months back might not have significantly changed the course of illness.

I am not able to view any screen shots. May I request you to please add the images again.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (20 minutes later)
Hi Again, thank you very much. Unfortunately, there is about 172 or more image on cd. It is not possible (It will only attach one image at a time) to attach all 173 or more images for you to look at. I am not a medical doctor, so, I have no idea of which images are with in the pancreas tail. You have to attach one image at a time, I can't do that.

The one question, I want to know for my peace of mind, would and expert World renowned Oncologist like yourself or a Expert Oncologist Radiologist be able to spot that this was indeed not scar tissue, and that it was a tumor size of 2.6 x 2..3 x2.2.

Last, I have called 30 hospital in XXXXXXX to see if I could get a second opinion for a Oncologist Radiologist to read the cat scan. Nobody in the united states will do this unless it the patients goes to a new hospital or doctor to been seen by them. The patient is very sick, and his progressive is extremely poor, and does not have much time. I can't put him through that. At the end it means nothing to him.

I would be willing to see you the cd with all of the scan on it for you to review if you want. I know you are in XXXXXXX If you want, just give me the complete address to send to, and I will get it to you.

I hold nothing against you, if you can't do this. Please let me know either way. Thank you.
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Follow up: Dr. Vivek Chail (0 minute later)
Hi Again, thank you very much. Unfortunately, there is about 172 or more image on cd. It is not possible (It will only attach one image at a time) to attach all 173 or more images for you to look at. I am not a medical doctor, so, I have no idea of which images are with in the pancreas tail. You have to attach one image at a time, I can't do that.

The one question, I want to know for my peace of mind, would and expert World renowned Oncologist like yourself or a Expert Oncologist Radiologist be able to spot that this was indeed not scar tissue, and that it was a tumor size of 2.6 x 2..3 x2.2.

Last, I have called 30 hospital in XXXXXXX to see if I could get a second opinion for a Oncologist Radiologist to read the cat scan. Nobody in the united states will do this unless it the patients goes to a new hospital or doctor to been seen by them. The patient is very sick, and his progressive is extremely poor, and does not have much time. I can't put him through that. At the end it means nothing to him.

I would be willing to see you the cd with all of the scan on it for you to review if you want. I know you are in XXXXXXX If you want, just give me the complete address to send to, and I will get it to you.

I hold nothing against you, if you can't do this. Please let me know either way. Thank you.
doctor
Answered by Dr. Vivek Chail (19 minutes later)
Brief Answer:
Please upload complete CD to Drop box or Google drive and share link

Detailed Answer:

Hi,
Thanks for writing in to us.

Can you please upload the entire CD to Drop box or Google drive and share the link to my email YYYY@YYYY

Please send me a follow up query after uploading images so that I will check my email.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
Please upload complete CD to Drop box or Google drive and share link

Detailed Answer:

Hi,
Thanks for writing in to us.

Can you please upload the entire CD to Drop box or Google drive and share the link to my email YYYY@YYYY

Please send me a follow up query after uploading images so that I will check my email.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (1 hour later)
Hi, this will take a few day, my neighbor across the street is familiar how to do this. Unfortunately, he is sick but as soon as he can do this, I will email to your address. Unfortunately, I don't have a cd drive on my laptop, but he mostly likely has a drive he can hook up to my computer. I will tell him to follow your direction how to do this. and let you know that he did it. Thank you
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Follow up: Dr. Vivek Chail (0 minute later)
Hi, this will take a few day, my neighbor across the street is familiar how to do this. Unfortunately, he is sick but as soon as he can do this, I will email to your address. Unfortunately, I don't have a cd drive on my laptop, but he mostly likely has a drive he can hook up to my computer. I will tell him to follow your direction how to do this. and let you know that he did it. Thank you
doctor
Answered by Dr. Vivek Chail (23 hours later)
Brief Answer:
Sure, please write in once the files uploading is done.

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

Sure, please write in once the files uploading is done.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
Sure, please write in once the files uploading is done.

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

Sure, please write in once the files uploading is done.

Regards,
Note: For further queries related to kidney problems Click here.

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

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What Can New Hetergeneous Soft Tissue Density Mean In The

what can new hetergeneous soft tissue density mean in the region of pancreas tail resection which is abutting the kidney. Does that mean it either scar tissue or a tumor on the tail of pancreas. Thank you. it measures 2.6 x 2.3 x 2.2cm. Thank you