In addition to supplying family and friends with important information such as Debbi’s feelings, hopes, fears, and dreams, we are using the blog to record many of the test results for our own records. If you are not interested in this info, please simply scroll forward/backward as necessary.
As you know, biopsies were taken of the right kidney and the left scapula. The diagnosis was:
1) Kidney Mass, Right Kidney, Biopsy
Compatible with high grade urothelial carcinoma. The pattern of tumor invasion is unusual in that it appears to have a tubular architecture surrounded by basement membrane-like material in a background of myxoid stroma. This likely represents intratubular spread of the urothelial carcinoma into renal tubules. Immunohistochemical stains are consistent with urothelial carcinoma (CK7, 34BE12, 4A4 Positive; CK20, CD20, CD31 Negative).
2) Scapula, Left, Biopsy
Blood and hematopoietic elements. No carcinoma seen. Multiple levels examined.
Reading between the lines, we are very happy that the scapula is not involved even though there was some evidence of cancer in the PET scan. When the biopsy was done on Debbi’s right kidney, the interventional radiologist, Dr. Constantinos T. Sofocleous, was able to place the probe and use the CT scan to verify that the location of the probe was consistent with the location of the mass. However, this verification process was not available for the biopsy of the scapula. Bone is solid and dense. Therefore, the radiologist did his best to use existing scans and multiple screens to try to triangulate the area for the biopsy. Considering that the involved area was approximately the size of the head of a thumbtack, it was difficult to be 100% certain that the biopsy was taken from the exact area. Four sample bone scrapings were taken with the largest one measuring approximately 0.25″.
Where does this leave us??? Since we are not absolutely sure that there is no involvement outside of the kidney, we must do chemo in an effort to shrink the tumor in the kidney as well as to treat any possible cancer cells that may be traveling through the blood stream (as well as any possible cancer cells in the left scapula). If the chemo is successful in shrinking the tumor, surgery to remove the right kidney (or part of it) becomes possible.
In the next post, I will try to explain the choices for chemo and how we move forward.