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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: Exophytic / Heterogeneous Enhancement on Lower Left Kidney

 sk72 - Tue Dec 15, 2009 11:45 am

Hi Doctor,

My Dad was recently diagnosed with a stone on his left kidney which has been causing him a lot of pain. While performing a regular XRAY, the radialogist found that that there was a slight swelling on his left kidney and recommended for a Utra Sound and a CT scan. The results of the CT scan was a below;

"Exophytic Heterogeneous Enhancement: Well defined rounded mass in the lower pole of the left kidney measuring 2.4 * 2.6 cm. No focal NODULE seen to suggest METASTASIS"

"Left HYDRO METHROSIS due to a stone in the left upper ureter, no evidence of METASTASIS"

The local doctor is going to be performing a scope to remove the stone but we are more worried about the solid mass which was found on his lower part of the kidney. What are the chances of this growth being cancerous, the local doctor is suggesting partial kidney removal to save the kidney or a full kidney removal if there is any traces of spreading. My father turned 56 last august and he's most recent medical checked out perfectly fine including his blood test as he is a diabetic.

We are all very worried about my Father as the doctor is suggesting that it could be a cancer but it's good that we have detected it quite early. My readings over the internet is suggesting otherwise as it can be a belign and until a biopsy is done, it is quite difficult to come to any conclusion.

I would really like to hear your advice on this and how do you think we should proceed. My mother has scheduled an appointment with another doctor from a different hospital to get a second opinion as well.

Thank You
 Dr.M.Aroon kamath - Thu Dec 24, 2009 9:57 am

User avatar Hi,

There are a number of possibilities for the CT appearence that you have provided. But, all of these conditions have to be differentiated from a renal cell carcinoma.

The other way of saying this would be that "any renal lesion showing these CT features should be presumed to be renal cell carcinoms (RCC) unless proved otherwise".
Although many conditions(many of which are quite rare) potentially can cause these CT features, i will discuss one important condition which merits special mention - renal 'angiomyolipomas' (AMLs).

There are many varieties of this tumor.
From purely intra-renal to predominantly extra-renal with a small intra-renal component. Also, their architecture varies. It could range from purely fatty tumors to ones with undetectable fat content on CT imaging.Their vascular pattern also varies.
They can be asociated with intra or extra renal hematomas.

Depending on these variations, their CT appearence also varies from those with 'homogenous' or 'heterogenous' enhancement.

It is quite likely that your father may be ultimately diagnosed as having an angiomyolipoma.But, that will be done only after thorough investigations to exclude a RCC.

Best wishes!

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