6mm nodule in pleura

Well I managed to translate everything and send CT scans and everything else to Mayo.

After about hours I get a reply "our team of specialists do not feel that Mayo Clinic has anything significant to add to the current treatment plan". I asked if I should understand this as a "second opinion" and they just repeat the same thing. So as last question I ask if they looked at my CT's and they said that they reviewed all pictures I sent. Finally they told me to contact again if my medical condition deteriorates.

I guess its a second opinion but didnt give me a real answer about the nodule.

But later I received a call from my brother who had visited doctor in Vienna about my case and he said that there is no reason to leave it there: It doesnt belong in the body and it is causing great deal of stress to the patient. Futhermore he said that it is really easy to remove. Finally he recommended a surgeon who could do it.

The doctor also told my brother that whatever I have in the lung has been there over 2 years since it was seen in first image, and that if it was aggressive, it probably wouldve grown faster. He also has treated about 15 adenocarcinoma rete testis cases during his career. Its still not common but clearly not as uncommon as the scientific literature makes it look like. So that also was a bit more reassuring.

So now I'm waiting for appointment to surgeon. I feel like I can breathe again. Also the pain in my chest is gone, mustve been the stress.

Sorry to hear that Mayo didn’t offer much help, but the rest of your message all sounds very encouraging!

Well it was helpful in the sense that they didnt see it as serious enough. Which is not nothing. Second opinion was what I was after first anyway, but ultimately removal of the nodule because it does cause great deal of stress.

I agree that it is a valuable second opinion knowing Mayo does not feel the need to jump in and recommend something different. Now you can breathe a little and pursue a potential surgery to remove this and find out what it is. The slow growth should also ease some of your worry. You are a great advocate for your own health care. Keep up the good work.

Great comment, gives hope to so many. Stay healthy, God blesx

I want to continue my story.

It is the day after my surgery in Vienna and the nodule is gone. Doctor said it was really easy opetation, done with VATS. It took them less than hour and I was able to walk independently the same day.

The minutes before they pushed me to the operating theatre I was having serious second thoughts about the whole thing: Is this really smart thing go do, is this a good idea? I still had those feelings when I woke up in the operating theatre. Rest of the day I spent in the twilight: I was feeling really sleepy, couldnt keep eyes open but I couldn't fall asleep either. Surgery was at 3pm and I couldn't sleep again until 2 am for 3 hours.

But now that I'm awake I'm glad I went through it. I have no regrets having it done sooner rather than later, although I'm sad I had to cut my honeymoon short. But at least now I'm married. I love my wife. She was so understanding and encouraging despite all. She could see how I can't properly enjoy my life while the nodule is in my chest and in my mind.

The chest pain is gone. Sure, when I breathe in quickly and deep, it hurts a bit. And the drain in my chest hurts like any other small wound would. But that burning, squeezing and glass shard like pain is gone from my chest. So is the shoulder pain. Maybe the pain was psychological like the finnish doctors said, or maybe it was real like I said. What matters is that its gone.

I was never afraid of the surgery. I got operated on by the best thoraic surgeon in whole Austria, same person who performed the first lung transplant here. He is retired but my brother told me that people like him can never truly retire, because it is their passion.

What I am afraid however, is what comes next. Nobody still knows what they exactly removed. Nobody knows for certain what they actually removed in 2022, since the histopathology was so unclear and frankly chaotic. Nobody knows yet if my CEA values are affected by this surgery or not. Nobody knows if this nodule was metastasis, primary or secondary or something benign even.

Large part of me doesnt even want to know. I understand now what they mean by overdiagnosis and overtreatment. Big part of me wants to settle with this, and if I end up dying from it, so be it as I would rather die not knowing about it than looking at the slowly approaching black hole.

Equally large part of me wants to expend all possible resources to figure out what this is, continue monitoring and immediately react to anything they find.

I sort of have all feelings on at the same time: Joy and happiness of marriage, relief of surgery and the gratitude for expertise of the staff, gratitude for the opportunity, pride that I have taken things into my own hands, disappointment and resentment towards Finnish healthcare system, being betrayed by the system by giving the impression of individual level treatment, anger towards the taxes and in general how ineffective and nonflexible everything is, fear what will come next, dread that my decision was incorrect, hope that my path is correct and nothing more will come up.

Theres much more, but it really is like that. Literally whole spectrum of emotions all on at the same time. And in the center of ir all its neutral, like eye of the storm.

My wife told me that I need to separate the rational and irrational. That I must be analytical and keep emotions out of it. I think she is right. I love you.

Time will tell what comes next. I hope it is good.

Congrats on your upcoming marriage I wish you and yours the very best. I had thyroid cancer in a lymph node in my chest accident found when I was having chest surgery for something else entirely. A thyroidectomy was performed and I was told there was absolutely no signs of cancer in my thyroid. I had a chest CT and there were nodules found in my lungs - they have caused me no problems and this all took place 20+ years ago. Mine was also adenocarcinoma in the node in the chest. My situation may be completely different than yours but I am
Hoping yours is also a benign finding. Have you had the opportunity to visit with your doc about the rising levels you discovered when you asked for a repeat test?

I have not yet had followup for the CEA yet. The difference for 8.7 and 5.2 is because of different laboratories. My latest value is 8.6. So depending where I measure it hopefully is below 8.6 or 5.2. But measuring it too soon after surgery is maybe not that useful.

Hi. You have a very smart and kind wife. Don’t overthink your situation. You have done all the right things so far. Enjoy every day. Together, you will figure it out once you are presented with more information.
We had the same reaction to our health care system’s inflexibility and lack of good options (in Canada). We went to the States for excellent care. In the end you must take personal responsibility and initiative for our health and our lives are the most precious things to ourselves and our loved ones. All the best to you.

The plot thickens: Preliminary studies on the nodule were morphologically similar as in my testicle, but further analysis has indicated that it is not metastatic. Meaning that the lung nodule is primary and not from testicle and not rete testis carcinoma.

Now theres two possibilities:
1. I have (had) two different cancers, one in testicle and one in lung
2. The lung cancer has spread to testicle (when it was < 2mm in size??)

Now #2 is incredibly unlikely. Not only because the nodule in my lung was about 2mm in size when my testicle was removed but because testicles are also regarded as "sanctuary" where cancers in general have very difficult time metastasize to.

Of course I am a bit worried that the nodule might have spread already because pathologist literally writes "geringer Lymphangiosis carcinomatosis im Randbereich" meaning "slight/low lymphatic carcinomatosis in peripheral area". Most likely meaning that it is already invading lymphatic vessels/nodes but still a bit uncertain if it has fully invaded it allowing metastases.

But overall I am relieved because rete testis adenocarcinoma has very poor response to any other therapy other than surgery. I will hopefully read the full report on next monday.

Still more than 100% worth the money. They do phenomenal and thorough work here. These news also slightly lessen my anger towards Finnish healthcare system, but only slighlty because they still wanted to wait for it to grow.

This is quite the rollercoaster but I sure wish the ride would end happily soon.