Case #2
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Physical Exam
04/08/XX
42-year-old female found to have L kidney mass during workup for abnormal liver function tests. No gross or microscopic hematuria.
X-Rays & Scans
03/01/XX
CT abd/pelvis with contrast: 20 x 17 mm small mass lower pole left kidney, small para-aortic and celiac axis lymph nodes.
03/03/XX
Abdominal ultrasound: < 2cm lower pole solid left kidney mass.
Chest X-ray: no acute disease.
Operative Findings
04/08/XX
Left kidney with multiple cysts, large amount of fat removed over operative site. Wedge resection with 1 cm perimeter taken around whitish solid lesion.
Pathological Reports
04/08/XX
L partial nephrectomy specimen size 5 x 5 x 3 cm with a 1.6 cm Grade 1 renal cell carcinoma confined to renal capsule, margins negative. Adipose tissue without evidence of tumor.
Treatment
04/08/XX
Surgery: L partial nephrectomy.



