Von Hippel Lindau. History of renal cell carcinoma and pancreatic tumor/cysts. Evaluate growth of existing pancreatic lesions and presence of new lesions. Prior left upper pole resection for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Stable appearance of a lobulated and septated segment 7 hepatic cystic lesion. The common bile duct is displaced anteriorly by a large pancreatic cyst which may account for the slight increase in biliary ductal dilatation, now moderate.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma is completely replaced by multiple cystic lesions, some of which contain proteinaceous fluid/hemorrhage. An enhancing lesion within the pancreatic tail measures 2.0 x 1.7 cm (series 100, image 67), unchanged. Medial to this lesion there is an additional enhancing lesion that measures 1.4 x 1.2 cm, not substantially changed from prior (series 100, image 60). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cysts bilaterally. Status post partial left nephrectomy, with no evidence of local recurrence. Increased size of a complex cystic lesion within the right inferior pole measuring 2.0 x 1.8 cm (series 102, image 20), previously 1.7 x 1.6 cm, suspicious for renal cell carcinoma. Additional subcentimeter lesion within the midpole contains mural and septal enhancement and remain suspicious (series 1202, image 39).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Slightly increased size of an enhancing nodular lesion within the right lower pole, probable renal cell carcinoma. Additional suspicious right midpole lesion is unchanged. 2.Status post left partial nephrectomy, without evidence of local recurrence. 3.Increased biliary ductal dilatation due to pancreatic head cyst.4.Unchanged enhancing pancreatic lesions suspicious for islet cell tumors.