Diagnosis
Solid space-occupying lesion in the middle and lower calyceal groups of the left kidney's inferior pole. Small co-existing angiomyolipoma in the lower pole of the left kidney.
Patient:
Female, 32 years old, Kazakhstan
Physician:
Prof. Dr. med. Michael C. Truss, Head of the Department of Urology, Clinic Dortmund
Patient’s Medical History and Inquiries:
A routine ultrasound examination revealed an irregularly shaped, solid mass measuring 4.5 x 3.1 cm in the central region of the left kidney. To clarify the nature of the lesion, magnetic resonance imaging (MRI) and computed tomography (CT) scans were performed.
Local physicians initially suspected a benign angiomyolipoma. The patient currently exhibits no clinical symptoms or discomfort related to this condition. Nevertheless, her attending physician recommended a complete surgical removal of the kidney (nephrectomy).
The patient sought a second opinion from a leading German expert to verify the diagnostic approach and explore potential nephron-sparing options.
Surgical Assessment by Urologist Prof. Michael C. Truss:
Upon reviewing the MRI scans, a solid tumor measuring 4.4 x 3.0 cm is clearly visible in the renal hilum of the left kidney, showing no distinct fat components. The lesion exhibits lower contrast perfusion compared to the healthy surrounding renal parenchyma.
Based on these radiological features, we are not dealing with a benign angiomyolipoma, but most likely with a malignant process—specifically, a renal carcinoma or urothelial carcinoma. However, a definitive histopathological classification must be confirmed through further diagnostic evaluation.
To establish an precise treatment plan, the following diagnostic steps are recommended:
- Renal Scintigraphy (Radioisotope Scan).
- Endourological Diagnostic Workup.
- Surgical Intervention: Radical nephrectomy.
While partial nephrectomy (nephron-sparing surgery) is our preferred approach for kidney tumors, it is unfortunately not technically feasible in this case due to the tumor's central hilar localization. A radical nephrectomy will most likely be required to ensure complete oncological control."