Abi-Jaoudeh: I usually use cryoablation for treating kidney lesions. What are the unique risks associated with treating this lesion, and what modality would you use for treatment?ĭr. Treatment via ablation would be a consideration.Īxial and coronal portal venous phase CT scans demonstrating a solitary, 3.2-cm, right-sided adrenal colorectal metastatic lesion, with displacement of the liver capsule, adjacent to the inferior vena cava (IVC) with mass effect. Abi-Jaoudeh: I would normally examine all available imaging and histology, in addition to the clinical history. If axial and sagittal images show the tumor to be in proximity to the renal pelvis and ureter, I would proceed with pyeloperfusion.ĭr.
If the lesion is a biopsy-proven renal cell carcinoma, I would proceed with CT-guided cryoablation. 2 Therefore, it is important to prove malignancy prior to treating this challenging central tumor. Per a published article by Tuncali et al, approximately 37% of solid masses are benign tumors. Uppot: My approach to this case would be to first obtain proof that this is a malignant tumor.
1 Although treatment by ablation would be difficult and potentially complicated, it would seem that the patient has little to no options, and therefore, I would likely still treat this with radiofrequency ablation (RFA) with pyeloperfusion.ĭr. I would estimate the RENAL score to be 10. However, using the RENAL scoring system, the lesion is highly complex due to its endophytic location, nearness to the collecting system, and its central location. Ho: Given that the patient is a not a surgical candidate, percutaneous treatment seems to be the only option. In a patient who is not a surgical candidate, how would you treat this lesion?ĭr. A coronal portal venous phase CT scan showing a 3.2-cm central renal cell mass, with displacement of calyceal fat, adjacent to the collecting system.
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