.: my story.doctor's reports

Over the course of my treatment and investigations, this is what the doctors have told me.

Report # 1, IVP with Neprotomography
Date: November 3, 2004

Clinical Information: Hematuria

The survey of the abdomen shows faint calcific densities overlying both kidneys. The remainder of the abdomen is unremarkable.

The urologic system was evaluated following the intravenous injection of contrast material and shows simultaneous concentration and excretion of the contrast from both kidneys. Both kidneys appear markedly enlarged with what appears to be a large mass in the inferior pole of the left kidney. I cannot definitely explain the enlargement of the right kidney as there does not appear to be any splaying of renal collecting system. This could be due to a congenital variant. CT of the kidneys is recommended for further evaluation. There are no filling defects or obstructive findings identified. Free flow of the contrast is seen through both ureters which traverse a normal course to the urinary bladder. The bladder appears intrinsically normal with satisfactory evacuation.

Report # 2, CT of Abdomen - Mass
Date: November 5, 2004

Abdomen was examined in contiguous axial sections from the lower thoracic region to the pelvis with and without intravenous and with oral contrast.

On scanning through the lower thoracic region no pulmonary abnormalities are noted as visualized. Bilateral renal masses are identified. Te mass in the inferior pole of the left kidney is approximately 14 cm in greatest diameter. The mass in the upper and mid right kidney is approximately 10 cm in greatest diameter. Biopsy is needed for further evaluation. There is stranding of the perinephric fat around the left kidney and local invasion of the fat and fascia cannot be excluded. A single enlarged lymph node is seen in the periaortic area on the left side … No other adenopathy or metastic disease to the live is seen. Both adrenal glands and the pancreas are negative. There are no abdominal masses or ascites seen.

Report # 3
Date: November 18, 2004

...he then received a CT scan and was found to have bilateral solid tumors in the kidney with calcification and the contrast shows necrosis of the tumors, which is almost typical for renal cell carcinoma bilaterally...

On examination, the abdomen is soft. No masses palpable…

PLAN: I explained to the patient that this is most likely representing bilateral renal cell carcinoma. There are slightly enlarged nodes in the periaortic area, which may represent node metastasis. The CT of the liver appeared normal, but the liver function was slightly higher than normal, which may signify micrometastasis to the liver…I will review the film with the radiologist and then we will decide what the next step is… He may need bilateral nephrectomy and dialysis…

Report # 4, Total Body Bone Scan
Date: November 29, 2004

Clinical Information: Evaluate For Metastatic Disease

Following the intravenous administration of 27.5 mCi of Tc 99m-MDP, anterior and posterior whole body images were obtained. Activity is present within both kidneys and the urinary bladder.

Mild increased activity is noted involving the right acromioclavicular joint, the tricompartmental joint spaces of both knees, greater on the right, and the tarsal bones of both feet indicating degenerative change. No cocal area of abnormal activity is seen to suggest metastatic disease.

Conclusion: No scintigraphic evidence for osseous metastatic disease.

Report # 5, CT of the Chest w / Contrast (ISOVUE 300/125 cc)
Date: November 29, 2004

Clinical Information: Evaluate for metastatic disease.

No pulmonary nodule or pleural effusion is identified. The heart and pericardium have a normal appearance. No mediastinal or hilar adenopathy is present.

Within the visualized portion of the abdomen, the adrenal glands are not enlarged. The liver and speen have a normal appearance. An 8.2 cm hetrogeneously enhancing mass involves the anterior mid-pole of the right kidney, highly suspicious for renal cell carcinoma. A timy amont of gravel is present within the dependent portion of the gallbladder.

Conclusion: No mediastinal or hilar adenopathy. No pulmonary nodule. Large right renal mass. Small amount of gravel within the gallbladder.

Report # 6

...at the present time ... he also requests a nephrectomy on the left side first, which is a bigger tumor about 15 cm and he will try to look for alternative medicine so hopefully he does not have to have a nephrectomy on the other side... He also desires to wait for three or four months before we talk about right nephrectomy because he thinks dialysis at his age and condition the prognosis is not good. I told him it may be a good idea to have a second opinion from … and hopefully … will persuade him that it may be a better choice to have a bilateral nephrectomy soon so hopefully we can put him on dialysis and hopefully he can get renal transplantation earlier.

Report # 7, CT of the Abdomen with Infusion
Date: December 23, 2004

Clinical Information: Bilateral renal mass. Evaluate for possible renal malignancy.

Following the uneventful bolus intravenous administration of contrast, spiral CT of the abdomen was performed from the dome of the diaphragm thru the iliac crest with delayed images thru the kidneys.

Findings:

Images thru the lower chest show no evidence of pleural or parenchymal nodule nor pleural effusion. There is mild diffuse fatty infiltration of the liver. The liver and spleen are normal in size and density except for a tiny calcified granuloma...

A 9.7 x 9.2 cm fairly well circumscribed heterogeneous mass is seen arising from the anterior aspect of the right upper pole of the right kidney along with central nonenhancing attenuation area and peripheral rim of heterogeneous enhancement with some areas of dystrophic calcification.

An 11.8 x 10.2 cm mass is also seen arising from the lower pole of the left kidney, with heterogeneous peripheral enhancement and central low attenuation nonenhancing areas as well as areas of punctuate dystrophic calcification. Mild fat stranding is seen adjacent to the inferior aspect of this mass…

...The abdominal aorta and inferior vena cava are unremarkable. Multiple mildly enlarged left periaortic, pericaval and retrocrural retroperitoneal nodes are evident. The bony structures show no obvious lytic metastatic lesions…

Note: CT scans are read "backwards". The "right kidney" is shown on the left side of the left picture and the "left kidney" is shown on the right side of the right picture.

Report # 8
Date: January 5, 2005

PLAN: Thorough discussion with the patient about options of treatment was done. In terms of cancer control, bilateral nephrectomy and hemodialysis would have the surest removal of both tumors. However, the right lower pole may be salvaged with a complex partial nephrectomy done in-situ. The left kidney would require a total nephrectomy. Plan is to attempt partial nephrectomy on the right side to be followed by total nephrectomy on the left side as soon as feasible. He was advised a partial nephrectomy may not be feasible based upon intraperative findings. The status of lymph nodes can be assessed intraopteravely…

Report # 9, CT Brain Combined
Date: January 12, 2005

Clinical Information: Metastatic Work Up

Axial images of the brain were obtained without and with intravenous contrast enhancement.

There is a mild degree of generalized cortical atrophy. The brain substance is otherwise unremarkable without mass effect or abnormal attenuation. No abnormal gross enhancement is evident.

The included portions of the paranasal sinuses, middle and inner ears and mastoids appear unremarkable.

Report # 10, CT of the Abdomen
Date: April 25, 2005

Clinical Information: Known Kidney Tumors, Blood in the Urine

Liver and spleen show no focal lesions. Pancreas and adrenals are normal.

The right kidney shows a 8.1 x 6.9 cm necrotic tumor with calcifications and involving the upper half of the right kidney. On the left side noted is a larger necrotic tumor measuring 8.4 x 12.4 cm in size involving the lower half of the left kidney. There is a thickening of the perinephric fascial planes on the left side near the tumor. No hydronephrosis is seen on either side. Both kidneys are functioning symmetrically. Noted is a 1.5 cm enlarged lymph node in the periaortic region on the left side best noted on image #38. Periaortic fat is somewhat nodular and shows soft tissue changes in addition to these enlarged lymph nodes and this may represent additional lymphadenopathy in this region though not very discretely seen by CT.

Conclusion: Bilateral known renal tumors on the right involving the upper half and on the left involving the lower half with left being the larger of the two showing thickening of the perinephric fascial planes on the left. Both tumors show areas of calcifications and necrosis. At least one 1.5 cm enlarged lymph node in the periaortic region on the left side is noted.

Chest: Two view, PA, lateral

The lung fields are clear. An active infiltrative process is not appreciated. The heart, mediastinum and thoracic cage are intact.

Conclusion: Negative study.