From the Guidelines
The 3 mm nodule found anterior to the psoas muscle below the left kidney is likely not concerning for recurrent cancer, given the patient's history of partial nephrectomy for a 1.3 cm exophytic Chromophobe renal cell carcinoma (RCC) and the nodule's stable presence over time, as suggested by the most recent guidelines from the American College of Radiology 1. The patient's original cancer was small, without aggressive features, and classified as stage T1a, which has an excellent prognosis. Chromophobe RCC typically has a low risk of recurrence or metastasis, especially at this early stage. The small size of the nodule (3 mm) and its stable presence since shortly after surgery further support that this is likely benign. Some key points to consider in the follow-up of patients with clinically localized renal cell carcinoma include:
- The use of cross-sectional scanning (CT or MRI) with and without IV contrast to assess treatment success, as recommended by the American Urological Association 1.
- The importance of monitoring for local recurrence and distant metastases, with a focus on the lungs, lymph nodes, bones, liver, and adrenal glands, as outlined in the ACR Appropriateness Criteria 1.
- The consideration of individual patient risk factors in determining the frequency and duration of follow-up imaging, as suggested by the ACR Appropriateness Criteria 1. However, continued surveillance imaging according to the urologist's recommended schedule is important to monitor both the nodule and the kidney over time, with a focus on detecting any changes that may indicate recurrent or metastatic disease, as recommended by the most recent guidelines from the American College of Radiology 1. If the patient experiences any new symptoms such as flank pain, blood in urine, or unexplained weight loss, they should contact their doctor promptly.
From the Research
Nodule Characteristics
- The nodule in question is 3 mm in size, located in the fat anterior to the psoas muscle, below the lower pole of the left kidney.
- This information is relevant to the management of pulmonary nodules, but the provided studies primarily focus on lung nodules rather than nodules in other locations.
Relevance of Provided Studies
- The studies provided 2, 3, 4, 5, 6 primarily discuss the evaluation and management of pulmonary nodules, which may not be directly applicable to a nodule found in the fat anterior to the psoas muscle.
- However, the principles of nodule evaluation, such as considering the size and location of the nodule, as well as the patient's history and risk factors, may still be relevant.
Nodule Size and Location
- A 3 mm nodule is considered small, and the likelihood of malignancy is generally lower for smaller nodules 2.
- The location of the nodule, in the fat anterior to the psoas muscle, is not typical for a pulmonary nodule, and the provided studies may not be directly applicable.
Patient History and Risk Factors
- The patient has a history of Chromophobe renal cell carcinoma (RCC), which may increase the risk of developing other malignancies.
- The patient underwent a partial nephrectomy 3 years prior, and the nodule was found on imaging during follow-up.
Management and Follow-up
- The management of the nodule would depend on various factors, including the patient's history, risk factors, and the characteristics of the nodule.
- Further imaging or biopsy may be necessary to determine the nature of the nodule, but the provided studies do not offer specific guidance for a nodule in this location.