The Sixteen-Pound Tumor

Ladislav SkaldaPhoto: Christian Witkin

Medical Miracle #9
Problem: Forty-four-year-old photographer. Blood in urine, profuse sweating, weight loss, and anemia initially seen as minor ailments. Enormous tumor discovered on his kidney. Surgery could dislodge it, sending it to his heart. Wife seven months pregnant.
Doctor: Michael Grasso
Patient: Ladislav Skalda

When Ladislav Skalda spotted some blood in his urine last November, he wasn’t terribly fazed. Skalda was a robust 44-year-old freelance photographer and an avid athlete. A few days earlier, he had been moving boulders around the yard of his house upstate. He figured he must have overexerted himself. Still, he decided to visit his family physician. The doctor told Skalda that he had a minor infection and had no cause for concern. When Skalda mentioned that he had found himself sweating profusely, the doctor assured him that her husband sweated a great deal, too. Skalda added that he had recently shed more than 10 pounds from his 180-pound frame (he’d soon lose another 20). “I wish I could take off some weight,” the doctor responded drolly. Over the next few months, a swelling in Skalda’s testicles was dismissed as a hernia, and a case of anemia was treated, ineffectively, with iron supplements.

Skalda spent the winter in characteristically vigorous fashion—cross-country skiing for twenty miles nearly every day, visiting his parents in the Czech Republic, and preparing to relocate to Hawaii, where his wife, Catherine, who was pregnant with the couple’s first child, had already begun a new job. In early April, Skalda switched doctors. A few minutes into his initial exam, the new physician felt a mass in Skalda’s abdomen. A day later, a CAT scan revealed a rugby-ball-size tumor originating on Skalda’s kidney. “You better run for your life,” his doctor said.

Skalda did, landing in the office of Michael Grasso, chair of urology at St. Vincent Catholic Medical Center. As Grasso recalls, “This guy had a lot of bad things happening simultaneously.” The tumor had stimulated Skalda’s body to produce toxic levels of calcium. Skalda was severely anemic, and his blood had stopped manufacturing clotting agents, so there was a strong likelihood of bleeding to death during surgery. Above all, the tail of the tumor—described by Grasso as “the size of a hot-dog bun with a thick hot dog inside”—was growing inside the renal vein. If it were to break free, it could migrate toward Skalda’s heart and kill him instantly. “The outlook was so bad that you could say, ‘We can’t do anything; he’s going to die right here,’ ” Grasso says. “But you don’t tell that to someone whose wife is seven months pregnant.” Besides, Grasso, who often takes difficult surgery referrals, was not ready to accept defeat. “There was a small chance we could cure Mr. Skalda, and it was worth a try.”

Grasso instructed Skalda to have his wife fly home. He leveled with the couple: If nothing were done, he said, Skalda would die. He also said that the surgery might fail, and that Skalda might die on the table. Skalda knew what he wanted to do. He was determined to see the birth of his baby.

On April 8, Grasso went to work. The tumor had attached itself to the blood supply from Skalda’s colon and spleen, and also adhered to his pancreas. Grasso removed the spleen but saved the other organs. He pushed the tumor back far enough to loop a cinch around the inferior vena cava—the main vessel that drains blood from the lower half of the body into the heart—blocking the tumor from reaching Skalda’s heart. Then, over the course of six hours, Grasso extricated the mass in a single “giant unit”—one that weighed more than sixteen pounds. “This one was a tour de force,” Grasso says.

Skalda recovered with remarkable speed. His lymph nodes, which were swollen to the size of walnuts, were removed and tested cancer-free. Within six weeks, he had regained all but ten pounds of his original weight, had gone fly fishing, and was ready to reunite with his wife in Hawaii. His chances of remaining cancer-free, while not assured, are good, Grasso says, and he will soon undergo a round of immunotherapy to further bolster his odds of long-term survival. For the moment, though, Skalda’s sights are focused squarely on the near future. His wife is due to deliver a boy on June 14. “We haven’t got the name yet,” he says. “But there’s still time to sort that out.”

Medical Miracle #10: Three Patients, One Liver

The Sixteen-Pound Tumor