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What Do These Following Biopsy And CT Scan Reports Indicate?
Question: Hello, doctor.
History of partial nephrectomy in 2013, dx: chromophobe renal carcinoma. As part of an annual follow up, a retroperitoneal ill-defined enhancing mass first seen in 2015 on MRI and CT-scans, increased from 1.2 cm to 3.5 cm by Feb. 2017.
Per CT, differential diagnosis for sarcoma, lymphoma, metastatic disease, or fat necrosis. Core biopsy performed in Feb. 2017. Results below:
PERINEPHRIC SOFT TISSUE (CORE BIOPSY):
A,B. FIBROCOLLAGENOUS TISSUE WITH MILD CHRONIC INFLAMMATION. NEGATIVE FOR
CARCINOMA. The dense fibrocollagenous tissue shows focal myxoid changes and likely represent tissue periphery. There are scant perivascular infiltrate composed predominantly of small and mature appear lymphocytes. Spectrin and AE1/AE3 stains are negative."
Please advise -- are sarcoma and lymphoma excluded, based on this report? I feel like the IHC panel stains for sarcoma have not been done? Or are sarcoma stains necessary?
Additionally, the CT scan from February shows "Severe atrophy/hypoplasia of left hepatic lobe, likely congenital." Four previous CT scans done at another hospital in the past 2 years state: "Normal hepatic size and contour." Could the finding of atrophy be a mistake or it is not possible to misdiagnose liver atrophy?
What next steps do you recommend?
Thank you.
History of partial nephrectomy in 2013, dx: chromophobe renal carcinoma. As part of an annual follow up, a retroperitoneal ill-defined enhancing mass first seen in 2015 on MRI and CT-scans, increased from 1.2 cm to 3.5 cm by Feb. 2017.
Per CT, differential diagnosis for sarcoma, lymphoma, metastatic disease, or fat necrosis. Core biopsy performed in Feb. 2017. Results below:
PERINEPHRIC SOFT TISSUE (CORE BIOPSY):
A,B. FIBROCOLLAGENOUS TISSUE WITH MILD CHRONIC INFLAMMATION. NEGATIVE FOR
CARCINOMA. The dense fibrocollagenous tissue shows focal myxoid changes and likely represent tissue periphery. There are scant perivascular infiltrate composed predominantly of small and mature appear lymphocytes. Spectrin and AE1/AE3 stains are negative."
Please advise -- are sarcoma and lymphoma excluded, based on this report? I feel like the IHC panel stains for sarcoma have not been done? Or are sarcoma stains necessary?
Additionally, the CT scan from February shows "Severe atrophy/hypoplasia of left hepatic lobe, likely congenital." Four previous CT scans done at another hospital in the past 2 years state: "Normal hepatic size and contour." Could the finding of atrophy be a mistake or it is not possible to misdiagnose liver atrophy?
What next steps do you recommend?
Thank you.
Brief Answer:
Repeat biopsy is a must
Detailed Answer:
Hello dear.
I have gone through the details.
So in your case, it is quite possible that the needle hit the normal tissue during biopsy and hence is not suggestive of lymphoma or sarcoma and thus false negative. So, a repeat CT guided biopsy is indicated before ruling out cancer.
Moreover, a review of scans is required by another expert radiologist to look for any atrophy of left lobe in previous scans as it can't be missed easily.
Thanks and regards
Feel free to ask further
Repeat biopsy is a must
Detailed Answer:
Hello dear.
I have gone through the details.
So in your case, it is quite possible that the needle hit the normal tissue during biopsy and hence is not suggestive of lymphoma or sarcoma and thus false negative. So, a repeat CT guided biopsy is indicated before ruling out cancer.
Moreover, a review of scans is required by another expert radiologist to look for any atrophy of left lobe in previous scans as it can't be missed easily.
Thanks and regards
Feel free to ask further
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you, Dr. Sundriyal. Please clarify -- based on the biopsy report, can I be sure that sarcoma panel IHC stains were performed by the pathologist and are negative? What does negative spectrin mean? Correct me if I am wrong, but my understanding is that only cytokeratin and spectrin stains were done, and cytokeratin detects only epithelial cells, while sarcoma can be from mesenchymal cells. So I am worried that the hospital has not tested the tissue for sarcoma.
To perform sarcoma panel stains, is fresh tissue needed, or can it be done using the slides that have already been stained with cytokeratin?
With regard to the liver, I understand that it is hard to miss a "severe left lobe atrophy" on previous scans. However, is it easy to mistakingly see a severe atrophy where there is none, or when there is only very slight atrophy? I am concerned whether this could be an incorrect finding.
Thank you again.
To perform sarcoma panel stains, is fresh tissue needed, or can it be done using the slides that have already been stained with cytokeratin?
With regard to the liver, I understand that it is hard to miss a "severe left lobe atrophy" on previous scans. However, is it easy to mistakingly see a severe atrophy where there is none, or when there is only very slight atrophy? I am concerned whether this could be an incorrect finding.
Thank you again.
Brief Answer:
Yes. Sarcoma ihc has not been done
Detailed Answer:
Hello dear. Yes, the sarcoma ihc has not been done but again, the biopsy doesnt give any clue for sarcoma on morphology too. Moreover, i think thw biopsy hit the wrong part of tumor. So in my opinion a repeat review of biopsy or a fresh biopsy can be done. Ihc can be done on preserved slides too.
Regarding left lobe atrophy, severe term can only be used if it severe.
So please discuss again with your radiologist, both old as well as new scans.
Thanks and regards
Yes. Sarcoma ihc has not been done
Detailed Answer:
Hello dear. Yes, the sarcoma ihc has not been done but again, the biopsy doesnt give any clue for sarcoma on morphology too. Moreover, i think thw biopsy hit the wrong part of tumor. So in my opinion a repeat review of biopsy or a fresh biopsy can be done. Ihc can be done on preserved slides too.
Regarding left lobe atrophy, severe term can only be used if it severe.
So please discuss again with your radiologist, both old as well as new scans.
Thanks and regards
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Remy Koshy
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