Small Incidental Renal Mass
A 32 years-old-man was referred to Urology for an incidentally discovered 2.5 cm left renal mass with no evidence of metastasis.
The patient had a fever and right-lower-quadrant abdominal pain for which he visited the emergency department. An abdominal CT scan was obtained which showed a 2.5 cm incidental left upper pole renal mass suspicious for renal cell carcinoma. An MRI of the abdomen was performed which showed "a small complex enhancing cystic mass arising from the superior pole of the left kidney concerning for cystic renal cell carcinoma."
The patient denies abdominal pain or flank pain. He has no dysuria or hematuria.
The patient's past medical history is significant for biopolar disorder and hypothyrodism but has no pas surgical history. The patient is on bupropion, lithium, levothyroxine and nicotine lozenges. His labs are all within normal range. His urinalysis and urine cultures are negative.
Discussion:
1- What are your criteria for recommending active surveillance to patients with small renal masses?
2- Which imaging modalities do you use and at which frequency to follow small renal masses? What are your triggers for definitive treatment?
3- In which cases do you consider performing a biopsy?
4- In which types of patients would you consider cryoablation?
5- What would you recommend for this patient?
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May 18, 2024
Pending Moderator approval.