Need help again, RPLND

[ramfan13]

Hi everybody. I have a problem and am not sure how to proceed with this. I had left IO 8/05. CTs clear at that time. Pathology came back as Sertoli cell tumor, NOS. My AFP has been slightly elevated ranging from 14-16.5.
My PET scan in 10/05 was negative. Now my last PET scan on 1/4/06, nurse said that one of my lymph nodes in right abdomen "lit up." I did more bloodwork and AFP still just a bit high at 15. They want to refer me back to Urologist to take out this lymph node to see what they are dealing with.
Oncologist seems to think that this is not normal for Sertoli cell, if anything is normal with Sertoli. He feels that there may be some germ cell component, but they will not know until they do biopsy on lymph node.
I am not sure what to do. Would I have to get full RPLND or can they just take out one lymph node. Would it be ok to get a laporscopic RPLND for this. I am not sure if my urologist has experience with RPLND. There is another surgeon in St. LOuis who supposedly does lap RPLND, but I am not sure his experience either. This just seems weird not to know what we are dealing with here. I am just very confused by this whole thing. I did email Dr. Einhorn to see if he has opinion, but I dont want to waste any time in getting this done. Thanks if anyone has any ideas for me.

[dadmo]

ramfan13:
The only sure way to tell what's going on is to take the node out and examine it. If you can find a doc familiar with LRPLND that seems like it would be the way to go. From my understanding (and things are changing fast) during the LRPLND they will take the node do a frozen section and if it looks like cancer they will revert to a full open RPLND to clean up the rest. Now as i said things are changing and more doctors are familiar with the LRPLND, Scott on this forum was found to have active cancer during his LRPLND and they simply changed the entry pattern to facilitate the removal of the affected nodes.