u/BourbonBombero

Just got Pathology Report, could use a hand reading it

Of course I'll talk with my doctor about it, but it JUST hit and I'd like to learn as much as I can before I meet with the doc.

I had a Partial Nephrectomy on May 9. Tumor was 5.5cm x 5 x 3.5. Patho result as follows:

A: Kidney, left, partial nephrectomy, left renal mass --- or 37:

RENAL CELL CARCINOMA, CLEAR CELL TYPE, WHO/ISUP GRADE 3. (SEE COMMENT AND CAP PROTOCOL)

Parenchymal resection margin, free of tumor.

 

B: Perinephric fat, left perinephric fat -- or 37:

Fibroadipose tissue, no tumor present.

Immunohistochemical stains show that neoplastic cells are immunoreactive for CD10, CAIX, Vimentin and immunonegative for CK7, Cathepsin K. BAP1 shows retained expression in tumor cells. These results support the above diagnosis.

TUMOR

Tumor Focality: Unifocal

Tumor Site: Upper pole

Tumor Size: Greatest Dimension (Centimeters): 5.4 cm

Additional Dimension (Centimeters): 5.3 cm

Additional Dimension (Centimeters): 3.5 cm

Histologic Type: Clear cell renal cell carcinoma

Histologic Grade (WHO / ISUP): G3, nucleoli conspicuous at 100x magnification

Tumor Extent: Limited to kidney

Histologic Features: Sarcomatoid or rhabdoid features not identified

Tumor Necrosis: Not identified

Lymphatic and / or Small Vessel Vascular Invasion (excluding renal vein and its segmental branches and inferior vena cava): Not identified

MARGINS

Margin Status: All margins negative for invasive carcinoma

REGIONAL LYMPH NODES

Regional Lymph Node Status: Not applicable (no regional lymph nodes submitted or found)

pTNM CLASSIFICATION (AJCC 8th Edition)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing physician's responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

pT Category: pT1b

pN Category: pN not assigned (no nodes submitted or found)

ADDITIONAL FINDINGS

Additional Findings in Kidney: Interstitial chronic inflammation

Gross Description

View trends

A:

Kidney, left, partial nephrectomy, left renal mass --- or 37: A partial nephrectomy specimen (7.5 x 6.3 x 5.5 cm) with attached perinephric adipose tissue (9.8 x 6.3 x 2.7 cm). The specimen is oriented by the surgeon and there is a portion of renal sinus at the resection margin.

 

There is a 5.4 x 5.3 x 3.5 cm red–orange soft well-circumscribed tumor present. The tumor shows areas of hemorrhage. The tumor abuts the renal sinus and is 0.2 cm from the resection margin. The tumor does not grossly invade into the perinephric adipose tissue.

 

The remaining kidney parenchyma is unremarkable.

 

INK CODE:

Blue–resection margin

Orange–renal sinus

SECTION CODE:
A1–A3, tumor with entire renal sinus interface and closest parenchymal margin

A4–A7, tumor with perinephric fat

A8, nonneoplastic kidney

BM

B:

Perinephric fat, left perinephric fat -- or 37: Consists of multiple pieces of yellow adipose tissue (7.0 x 7.0 x 2.0 cm). The specimen is serially sectioned and no lymph nodes are grossly identified. Representative sections in cassettes B1–B3.

ML

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u/BourbonBombero — 3 days ago

For a variety of reasons I elected to fire my previous Urologist. Coincidentally that same day I finally heard back from MD Anderson and have since handed over all of my care to them. Talk about a night and day difference, it's been incredible.

Their Urologist that I'm seeing feels very confident he can get good margins with a Partial Nephrectomy AND optimistically I might be able to maintain 75% renal function from that kidney. That is such an insane amount of optimism for a 5-6cm tumor. I think the doc MIGHT be a little overconfident, because holy shit that is such a great potential prognosis. Realistically if I can heal well and retain 33% or so I'd be thrilled, anything above and beyond I'm looking at as a bonus. I'm also well aware I could wake up from surgery to the news that they had to do a Radical after all, and Im at peace with that potential.

24hrs after my first visit at MDA they had me in for a CT with contrast to better map out their surgical options, but also to search for any spread of the cancer (yes I know it's not officially cancer yet, but at 5-6cm I'm in the 85-95% chance for malignancy so Im just calling it cancer). They also ran more blood and urine labs immediately after meeting with the doc and holy shit, this team had my results before I could even get back to my car. I've had 'good' medical care in the past, but I dont even know the words to describe how fast and efficient these folks have been. Short of being a billionaire I cant even imagine getting this level of care.

From first seeing a mass on ultrasound on April 13th to today has been one HELL of a rollercoaster, but Im feeling more optimistic today than I have during this entire month. Still some tough conversations to be had with my wife before I go under the knife, but we're both prepared to cross that bridge soon.

This sub has been great for realistically preparing me for what to expect and just the sheer amount Ive learned from everyone else's story. I hope to also be that resource for some folks going forward someday.

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u/BourbonBombero — 21 days ago