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Dr. Finazzo, we're back for round

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3 00:00:02,190 --> 00:00:04,330 three of this 84-year-old gal.

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She's got all kinds of lesions, and we're here

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at the Delicatessen with, uh, Pastrami now, and

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we've got, uh, a sort of solid-looking lesion

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on T2, and I say that because it's gray, you

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know, intermediate to low signal intensity.

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At least for me, in my primitive mind,

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conjures up things like oncocytoma, uh,

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chromophobe, uh, renal cell carcinoma.

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Yeah, they can be darker than this, but at any

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rate, it looks kind of solid on initial inspection.

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And then we go over to the GRE in phase and

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out of phase, and it still is pretty gray.

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And then we go over to the T2 fat suppression, and

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it's still pretty gray, also on the coronal projection.

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Then we go through our liturgy of time

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activity enhancement, and the lesion doesn't

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look like it has much enhancement at all.

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Down here at the bottom, we've got some subtraction,

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and for all intents and purposes, it's cold.

0:56

There's a little edge to it right there.

0:58

That might be some compressed tissue.

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Or it might be a little bit of misregistration,

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but inside this lesion, absolutely nothing.

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Would you agree?

1:06

Yes.

1:07

So, what do we do with it?

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She's 84 years old.

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And again, I think that this is a leave-alone lesion.

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There's no aggressive features.

1:15

It has no restricting diffusion,

1:18

um, and it does not enhance.

1:20

And I think this is another example of a different

1:23

way a protonaceous or complex cyst can, uh, be seen.

1:28

You know, we've got a high B value, um,

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diffusion-weighted image, and then an ABC map,

1:35

and you've got this funny-looking streak right

1:37

here, but it's very eccentrically positioned.

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So, it's probably a, a, a form of, of

1:42

artifact, perhaps a susceptibility artifact.

1:45

But when you go over to the subtraction image,

1:47

there's absolutely no papillary projections whatsoever.

1:51

Now, if you go back to the lesion that we looked

1:53

at in the last vignette, there is a little bit

1:55

of diffusion restriction that does correspond in

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its locus to an area of very delayed enhancement.

2:02

So we said on that one, especially, it's kinda

2:05

complex on, on the interior of it, I think watchful

2:08

waiting, that this could be some type of weird

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cyst with inflammation, but it could also be

2:13

a papillary projection from a papillary tumor.

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So we're not out of the woods yet with that lesion,

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and this patient's gonna be surveyed over time.

2:20

I think I mentioned to you that when you have a cystic

2:23

papillary tumor, they're more likely to have papillary

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projections, whereas when you have a cystic renal

2:28

cell carcinoma, more septa than papillary projections.

2:31

But we're stuck with this lesion.

2:33

We'll survey it over time, maybe at 3, 6, 9, and 12.

2:36

For a two-year time frame.

2:38

All right.

2:38

It's P and P out.