A recent MRI of the Abdomen

[bagelstreet225]

6/28/24- I am about to start calquence. I would appreciate your words of encouragement and advice. Follow-up mLeft upper pole 1.8 cm hypoenhancing solid renal lesion concerning for renal cell carcinoma, papillary subtype. Less likely differential of lymphomatous lesion.

Innumerable additional small foci of restricted diffusion scattered diffusely in both kidneys, most likely representing lymphomatous involvement of kidneys. Majority of the lesions are not well discernable on CT.

Enlarged abdominal lymph nodes reflecting known lymphoma, slightly decreased in size compared with prior CT 6/7/2024.

MRI ABDOMEN WITH AND WITHOUT IV CONTRAST

CLINICAL INDICATION: Renal lesions. History of small lymphocytic lymphoma.

TECHNIQUE: Multiplanar T1-weighted, T2-weighted, and diffusion-weighted sequences were obtained of the abdomen, including dynamic post-contrast T1-weighted sequences.

CONTRAST: 8.5 ml of GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION was administered (the balance of single use vial(s) has/have been discarded).

COMPARISON: CT from 06/07/2024

FINDINGS:

01. LIVER: Normal morphology and signal intensity. No suspicious lesion. Multiple simple and thin-septated hepatic cysts measuring up to 3.0 cm.

02. SPLEEN: Normal size. Few subcentimeter cysts.

03. PANCREAS: Normal.

04. GALLBLADDER/BILIARY TREE: No biliary duct dilatation. Normal gallbladder.

05. ADRENALS: Normal.

06. KIDNEYS: Symmetric renal enhancement. No hydronephrosis.

Left upper pole 1.8 x 1.6 cm T2 hypointense round lesion (series 4, image 17) associated diffusion restriction and low-level heterogeneous internal enhancement (series 14, image 36). This lesion is suspicious for primary renal neoplasm with less likely differential of lymphomatous lesion.

Innumerable additional small foci of restricted diffusion scattered diffusely in both kidneys (series 11 image 89-103) with low level enhancement and nearly isointense on precontrast T1 or T2 images, different from the left upper pole lesion, most likely representing lymphomatous involvement of kidneys. These are mostly subcentimeter in size, and the largest measuring 1.5 cm in the right upper pole (series 11 image 97), corresponding to the 1.0 x 0.7 cm lesion seen on CT. Majority of lesions are not well discernable on CT.

1.6 cm left upper pole simple cyst (series 10 image 43).

07. LYMPHADENOPATHY/RETROPERITONEUM: Multiple enlarged abdominal nodes including retroperitoneal and mesenteric lymph nodes, compatible with known lymphoma, as seen on recent CT, with reference lesions as follows:

-Anterior left para-aortic lymph node, 4.6 x 2.0 cm (series 11, image 96), previously 5.1 x 2.2 cm.

-Left para-aortic lymph node, 4.8 x 3.1 cm (series 11, image 104), previously 5.4 x 3.3 cm.

-Porta hepatis, 3.6 x 2.3 cm (series 11, image 88), previously 3.5 x 2.1 cm

-Mesenteric lymph node conglomerate, 7.2 x 2.9 cm (series 11, image 101), previously 7.0 x 3.8 cm

08. BOWEL: No bowel obstruction.

09. PERITONEUM/ABDOMINAL WALL: No ascites.

10. VASCULATURE: Normal caliber abdominal aorta. Patent portomesenteric vasculature. Encased bilateral renal arteries by retroperitoneal lymphadenopathy, which remain patent. Patent bilateral renal veins.

11. SKELETAL: No aggressive lesions.

12. LUNG BASES: No nodule or pleural effusion.

[cajunjeff]

Bagelstreet, I am totally unqualified to interpret your MRI report. That said, it appears that the radiologist was trying to image a lesion on your kidney that is suspicious for kidney cancer but they cannot rule out that the lesion is caused by your cll.

In the way of words of encouragement, I can comment as a lay person who is taking calquence. While the radiologist suspects renal cancer over cll, I wonder if the radiologist has seen many cases where Cll infiltrates the kidneys. To my understanding, kidney infiltration is not common with cll and even less seen by radiologists because kidney infiltration of cll cells, aside from being uncommon, usually doesnt cause symptoms that would trigger an mri.

It would then stand to reason the radiologist has not seen many cll kidney lesions to know it they might look like your suspicious lesion I would also think that since the mri did confirm the presence of cll cells in your kidneys, that would increase the chance of the lesion being cll.

In that case, it would be very likely that your cll cells everywhere, including in your kidneys, would rapidly be depleted or eliminated with calquence.

I debated responding with any opinions to you because I am no expert and do not want to give you false hope if it turns out you do have a secondary cancer. But you wanted some positive feedback and it did strike me, as a lay reader of the mri report, that the writer of the report does not seem to offer an opinion, one way or the other, if the lesion is renal cancer. He starts out by writing that from looking at earlier cat scan and that the lesion looked to be renal cancer. Perhaps with your history of sll, after your ct scan your doctor was suspicious for sll in your kidney and ordered an mri, perhaps because it is more sensitive a test than a ct scan is for cll.

I would have expected the mri radiologist to give an opinion as to whether the suspicious lesion was renal cancer or cll, but I didnt see him say that, but rather say that there are sll cells in your kidney. Its very possible as well that I am just not understanding the report. Since he did see cll cells in your kidney, might that make it more possible the suspicious lesion is also sll?

Your doctor should have the report and would be the very best person to tell you if you have renal cancer in addition to cll. I hope it’s just the cll, but both can be treated.

I do know a bit more than some in that I was initially diagnosed with cll after having blood in my urine. They suspected I had kidney cancer and the blood work revealed cll. My urologist scoped and biopsied my kidney for cancer and found no cancer and no reason for my bleeding. He supposed it was my cll, but my cll doctor said unlikely. In retrospect, maybe I also had cll infiltration into my kidney. No one ever tested for it. My kidney bleeding spontaneously got better, was it the calquence in retrospect?

Sorry for meandering. Good luck with your follow=up.

[bagelstreet225 in reply to cajunjeff]

Canjunjeff,

The problem is not imaging but how images are interpreted. For example, according to the CT radiologist, a lesion measuring 0.7 mm x 0.5 mm was discovered in the spleen and could be a possible neoplasm. The MRI radiologist disagreed. She talks about cysts. This is not a perfect science but a work in progress. Interpretation, experience, and for legal reasons, certain words are used, such as "suspicious." It's not uncommon. As you said, MRI radiologist states it could be related to sll or could not. That said, the lesion measures 1.8 cm x 1.6, which is about half an inch and is considered very small, isolated, and very treatable. Thank you for responding and for providing words of encouragement. I'm grateful. I will begin calquence on Monday, July 1, 2024. The medical appointment (follow-up) is set for July 9, 2024. You know, the hem/onco at NYU never talked about the spleen or kidney. This is SLL, he said and prescribed Calquence. However, let's dot our "i" and cross our "t," he said.

[bagelstreet225 in reply to cajunjeff]

Apologies are not warranted. We're here to support and encourage one another. Again, THANK YOU for responding. I'm grateful.

Respectfully,

Pat ( New York) is my hometown

[spi3 in reply to cajunjeff]

My hubby had a cyst on his kidney and is taking calquence. His renal Dr gave him 3 choices - freeze it, take it out or leave it alone. My hubby had this,cyst for a very long tine abd suddenly it grew a cm. So we decided to take it out. He just had surgery to remove the cyst and 6 weeks later playing golf

[SofiaDeo]

I haven't had strange kidney things, but during my initial workup when getting diagnosed a liver lesion was noted, and followup for possible cancer was recommended. Since my liver function was normal, and it was blood/bone marrow going crazy, I decided to focus on the urgent thing. My liver function tests have never gotten abnormal, and I never followed up on getting that lesion biopsied. I forgot about it, actually.

During my latest clinical study, the docs got a bit concerned when the CT scan showed that liver lesion again. When I told them I'd had it over a decade, they decided it didn't need followup.

I sometimes wonder if that lesion happens to contain CLL.

Another CT later in this same study showed some lung abnormalities. Those got me sent to a Pulmonologist for testing, to rule out a secondary cancer or infection. What was done, was a second CT to see if/how things changed. I was told if there was malignancy, the lesions would have grown.

So I think it's possible someone may want to repeat a CT, if they are concerned about that lesion. There's at least one person here who has had kidney issues from CLL, and treating the CLL is correcting them. This may be your case. If a repeat CT indicates a biopsy is warranted, or if this test is concerning enough they want a biopsy, whatever it is, you are addressing it really early.

[bagelstreet225 in reply to SofiaDeo]

Yes, the lesion is very small (1.8cm x 1.6 cm) and we are addressing it really early. Thank you for your words of encouragement.

[bagelstreet225 in reply to SofiaDeo]

Thank you for listening and providing sound advice. I will keep you posted.'

Pat from New York

[CaptRon1976]

I am treated with Calquence for 2 years now. 3 years ago ultrasound picked up a spot in the cortex of one kidney. It was seen again on imaging. Thought to be a cyst. Nephrologist wasn’t concerned. After 1 year on Calquence the “cyst” is gone.