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Gastroenterology  (Expert Forum)
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Liver lesion: hemangioma vs. malignancy?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
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MedHelp Member's Question

Liver lesion: hemangioma vs. malignancy?

by bbmax, Jul 30, 2003 12:00AM
Several weeks ago I had a non-contrast CT to check on a recurrent hernia. I went to see surgeon and he said the CT showed "spots on the liver". I am a nurse and this totally freaked me out. I then asked my doc for lab work and the results were: AFP: 2.2, AST: 23, ALT: 33. Alk Phos: 97, H/H normal except Hgb was high (16.1) and Calcium was 10.6. Bili was (total) 0.8. So all essentially normal, right? The CT report mentions 4 or 5 lesions possibly hemangiomas or other masses. Most about 2 cm. Biggest was 3.5  x 1.7 am. All in right lobe.

I am healthy. Non smoker, non drinker. take soy supplements for some menopausal symptoms (just starting). I am 53 and had my second child at 45. Had a negative mammogram 1 year ago (will have routine one next week) and negative sigmoidoscopy 1 year ago. NO symptoms, slightly overweight. No family hx of cancer. OK, I had the contrast CT 1 week ago and am waiting to hear reults from doc. I work at the HMO where all the tests have been done. I probably can find out the results by checking the computer when I go to work but I am afraid to. I just need some reassurance, not any guarantee. Is it likely to be hemangiomas if lab work is normal? Does not having any symptoms predict a better chance it is non-malignancy? Really would appreciate your input. I know liver spots if malignant are usually not primary but it seem like if it is some kind of mets I would have symptoms from the primary cancer (I know this may not always be the case but usually?) I KNOW I am being a wimp and should face the music but try to imagine what it is like to worry about this when you are in the medical field and also have two young kids to worry about. Thanks so much for helping.
Doctor's Answer

by Kevin Pho, MD, Jul 31, 2003 12:00AM
Hello - thanks for asking your question.



With no symptoms and normal liver function tests, the chances for malignancy is decreased.  Hepatic hemangiomas are the most common benign liver lesions.  In one study, 72 percent of people who were referred for liver lesions turned out to be hemangiomas.  The prevlance of hemangiomas range from 0.4 to 20 percent in the general population.  



For further study, I would suggest an MRI to define the lesion.  A fine needle biopsy can be considered for further evaluation.  Most hemangiomas are asymptommatic and have a good outcome.  If it causes discomfort, there are a variety of surgical and non-surgical techniques to treat the lesion.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.



FYI - I will be away from August 1-9th. I will look forward to answering your questions when I return.
Member Comments (13)

by surgeon, Jul 31, 2003 12:00AM
You are correct that with normal LFTs and no symptoms, the chances of malignancy are less. It may be that the contrast CT still won't give an absolute answer, and that other testing will be needed, so be prepared for that, too. The odds are it won't turn out to be bad; but, of course, it can't yet be said with certainty.

by bbmax, Aug 01, 2003 12:00AM
To: sugeon
Just an update to surgeon and Dr. Pho: the Ct with contrast came back almost for sure Ok but not definitive (as you said would probably happen).They are hesitant to do liver bx d/t possible bleeding. So now I have to have CT of chest to check for lung cancer (no hx) and then possibly colonoscopy to make sure no colon cancer (I had a sigmoidoscopy as baseline 2 years ago and was OK) and then a mammogram (last one was a year ago and it was fine). Any comments? This is all VERY stressful.

by macui, Aug 01, 2003 12:00AM
I had a very similar situation to yours and the lack of definative dx is very stressfull. Re a liver biopsy I would suggest you read about this procedure before considering to have it done. Bottom line is that you can have the biopsy and not gain a result ending up where you started. If you do have the biopsy I recommend that you know the experience of the radiologist doing the biopsy and the background/experience of the pathologist reviewing the sample  . I had a liver biopsy, ct scan with contrast & an MRI in an attempt to dx a 3cm lesion on my liver with no definative result. At the end of the day we opted to have followup comparative scans at six month intervals to monitor for grwth. My last of three scans was in May with no discernable grwth. I wish you the best of luck.

by bbmax, Aug 01, 2003 12:00AM
Dear maciu,

Thank you so much for your comments. You are the first person on any message board who seems to have a similar experience. I am on my way to work and needed a positive comment to help me manage the stress with my patients without worrying about myself. At this point I will have the CT of the chest and the mammogram but I think that is all if hopefully nothing shows up with any of those tests. This whole thing puts life in perspective, doesn't it?? BTW, why did you have the CT in the first place? I agree that a liver bx might be better to leave alone and just observe. Thanks again and I am glad there has been no growth. That is a great sign. It is amazing that so many of us have these hemangiomas and whatever but only know it after incidental scans. Might be better if there wasn't so much technology!!

by macui, Aug 04, 2003 12:00AM
To: bbmaxer
I had the scan on the advise of a gastro doc in response to pelvic discomfort. I read somewhere "When you go to a barber expect to get a haircut!" After the ct scan the doc's office simply left a message on my answering machine re a 3cm lesion was viewed on my liver. I absolutely flipped. The doc's office then said it would be several weeks before I could get a followup appt! Never having any health concerns in my life or immediate family I was quite uninformed. I immediately turned to the internet & convinced myself that something was terribly wrong. Although my doc was quite competant and reassuring that I probably had nothing to worry about I wanted a definative answer hence the biopsy and mri. My doc said nothing in life is certain but i couldn't understand why I couldn't get an answer. He did not deal well with my prolonged anxiety over this matter; silly is how I remember him responding to my fear. This was a hard lesson for me re the limitations of the medical profession, what's important to me and how powerful fear can be. I had taken my good health for granted and dealt with other peoples health concerns with a quiet arrogance.



I know the way I responded to this situation has much to due with my personality but I will say that with the news, medical technology, drug