A year ago I was diagnosed with Hairy Cell Leukemia in the hip area which I was told would need to be monitored for improvements with PETscans. My first PET Scan in August of 2006 showed high metabolic activity in the hip (as was expected) and the liver (4.2 SUV). My oncologist was suprised by the liver reading and ordered another PetScan. This PetScan showed the same results. I then had my chemo and the expectation was the chemo would knock everything out (hip and liver).
I just had my follow-up PetScan (this time it was a PET-CT scan) which showed no abnormal metabolic activity in the hip. The liver still shows metabolic activity (6.2 SUV). Should I request a liver biopsy ? I have put my latest PET-CT scan results below.
Multiple low-attenuation lesions were seen in the liver on a previous CT scan, but NOT on the current PET study. There is only one focus of increased activity, which is seen in the anterior aspect of the liver just cephalad to the gallbladder. This measures 1.7 cm in diamater on the non-infused CT image and has an SUV maximum of approximately 6.3
There is only one focus of increased activity seen in the liver. This is situated anteriorly just cephalad to the gallbladder. Neoplasm is not excluded.
I just realized you wanted the PET results from August 2006. I have put the August PET results below. The Feb 2007 PET-CT results are in the original post.
8/10/06 PET Scan
TOTAL BODY FLUORINE-18-FLUORODEOXYGLUCOSE POSITRON EMISSIONTOMOGRAPHY (PET SCAN):
Study date: 8/10/06.INDICATION: Patient has hairy cell leukemia/lymphoma of leftfemur.
Further evaluation of liver lesion seen on PET scan of 8/3/06.
Could this be a focus of uptake in loop of bowel anteriorto the liver?.COMPARISON:
Patient had previous study at this instituition 8/3/06.
Patient's blood glucose level was determined and wasfound to be 79 mg/dL.
About 13.01 mCi offluorine-18-fluorodeoxyglucose were then injected intravenously inright hand in a resting state. After standard delay, imagingliver was performed with a dedicated PET scanner starting fromabout the level of upper thighs to supraorbtital ridge.Image datawere reconstructed into axial, sagittal and coronal image setswith attenuation correction.
FINDINGS: A small focal lesion with elevated maximal SUV of
about4.2 is again demonstrated in anterior aspect
of the liver perhapsin right lobe of the lover. This is unchanged since the previousstudy of 8/3/06.
Recent CT scan is not available for comparison.No additional regions or foci of high metabolic activity are seen that cannot be accounted for by normal physiological processes.
IMPRESSION: Imaging limited to the liver again shows a metabolically active focal lesion in anterior aspect of liver,perhaps in the right lobe. This is consistent with metastatic disease.
It should be noted that "false positive" FDG uptake can be seen with hepatic adenoma. Correlation with recent CT scan is strongly recommended.
Addendum # 1 The FDG PET scan of 8/10/06 is reviewed with CT scan of the abdomen done at My hospital on 8/16/06. The comparison is as follows.
The metabolically active lesion seen in the anterior aspect of the liver probably in the left lobe near the gallbladderfossa, corresponds to a low-density lesion seen in this area on CTscan (series 3, image 92). The low density lesions seen on the CTscan do not show increased metabolic activity.
IMPRESSION 8/25: As reported earlier, liver lesion on PET scan is consistent with metastatic disease.
This correspond to alow-density lesion seen on the CT scan in this area.
The lesion from August 2006 was 1.5 cm. The May 2007 PET-CT shows 1.7 cm. Sorry I should have included that in the previous post.
One other thing I left out was I had a PET scan in Feb 2007 and the liver lesion showed SUV of 3.2. I am confused on what an SUV represents particularly in my case. It went from 3.2 to 6.3 in a couple of months.
There is a possibility the lesion in the liver is not related to hairy cell leukemia because:
1. Isolated liver metastasis are not a common feature of hairy cell leukemia. ( But then, neither is isolated lesion in the hip)
2. The lesion did not resolve with CDA ( CDA works in more than 90% of cases and your lesion in the hip did go away.
Your first PET.CT (done in aug 2006) does not comment on the size of the liver lesion. Follow up scan done, i assume in May 2007, measures the lesion at 1.7cms. It would be very helpful to know how big was the lesion in Aug 2006. If it was more than 1.7 cms and has shrunk, then that is good news. On the other hand if it was smaller and has grown despite CDA, then most likely it is not hairy cell related and a biopsy would be helpful.
COmparing SUV values from Aug 2006 and May 2007 is not that helpful as they are more or less in the same ball park. Comparision of size of the lesion is more important.
No, you cannot eliminate the possibility that the liver lesion is a tumor. It has grown slowly over 2 years and has a high SUV, consistent with a slow growing tumor.
PET CT is not the best way to charaterize liver lesions. COnsider a triple phase CT scan focussing on the liver or an MRI. These will provide more information about the nature of the liver lesion.
Thanks Boston, your information has been very helpful. I have a follow-up with my oncologist in late June to review all my scans and determine if a biopsy is warranted. My preference will be a wait and see approach (as I feel fine and my blood tests are fine), but obviously I will defer to my oncologist.
My blood test have been fine from day 1, although the bone marrow biopsy did show some residual HCL. Thus, my oncologist indicated I had a very rare case of HCL (only one other case of HCL has been reported was bone related only and not blood.). I walked around with a bad hip for over a year since I was mis-diagnosed with bone marrow edema. My hip got so bad the doctors decided to do a biopsy and thats when the HCL was discovered. I feel great now and am back to normal.
One final question: Am I able to eliminate the possibility that the liver lesion is primary cancer since this lesion appears to be very slow growing.
Lastly one piece of information I left out was I had a CT scan was done in August of 2005 when I first started to complain about my hip and the liver. I have posted it below. Thus 2005 was essentially clean, 2006 was 1.5, and 2007 was 1.7
Several small hypodensities too small to definitively characterize by CT, measuring up to 7.5 mm in diameter
Follow-up CT in 3-6 months may be appropriate to document stability.
So the lesion in the liver did not regress with CDA and has a high SUV. Most likely not related to hairy cell leukemia.
Your oncologist seems to be monitoring it closely with 3-4monthly PET scans.
If the lesion is superficial and can be safely biopsied, then consider a biopsy. If the lesion is deep and risky to biopsy (liver biopsy can some times lead to serious complications, bile leaks, lung punctures etc) then continue to monitor it periodically and biopsy if it keeps growing bigger. Dont worry too much about the SUV values, except for the fact that the SUV is higher than normal. Doesnt matter much if the size remains stable and SUV increases a few points.
I saw my oncologist and the plan is to wait until Novemebr to have another CT. Since my blood tests are fine and since the lesion is stable (was 1.5 in August last year and 1.7 in May 07). My oncologist is concerned that due to the uptake there is a possibility that this lesion represents a lymphoma. The hope is that perhaps this lesion will shrink. If it remains the same or grows I will need to have a biopsy. If I were to have a biopsy now and it is a lymphoma it is my understanding nothing would be done in terms of treatment since its slow growing. Are slowing growing lympomas not treated at all ? Do these become problematic in later years ?
I am being treated for hairy cell leukemia and am having sporatic pain in my left hip. The Doc at NIH thinks I have HCL in my hip, cat scan and MRI done, with a bone density scan to be done this wk. Anyone else have similar symptoms?
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