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Liver lesion: hemangioma vs. malignancy?
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Liver lesion: hemangioma vs. malignancy?

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.
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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.
14 Comments
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Avatar_n_tn
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.
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Avatar_n_tn
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.
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Avatar_n_tn
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.
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Avatar_n_tn
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!!
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Avatar_n_tn
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 ads on televions - there's a pill for everything, many docs inability to communicate with patients and doctors offices that process us through like chattle have a negative effect on people. It's no wonder we are frightened to death.

My thoughts are with you.

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Avatar_n_tn
Dear macui,
Thanks for answering. I am a nurse as I have already stated and I do feel horrible when my pts. are given bad news. Unluckily for me, I know how bad it can be and am really scared. I also have always taken good health for granted. What a shock when someone says you have "spots" on your liver! My surgeon, who I didn't know very well,made it worse with his worried look. But in my case I think they are going overboard with the testing and it just has me in limbo and feeling like I have a cloud over my life. Had the mammogram and hopefully that will be OK. Then the CT of chest in 2 weeks. That is probably it. Thanks for your positive thoughts.
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Avatar_n_tn
Hi I have also have the same situation going on with me right now.  In June, I had a CT scan and a 1.3 cm lesion was found on the left lobe of my liver.  I have had anxiety now over this for over three months and still no answers. An ultrasound was recommended to further characterize if hemangioma.  I had the ultrasound a couple of weeks later which showed it to be slightly hypoechoic so therefore would be an atypical hemangioma and an MRI was advised.  The MRI showed it to have characteristics of hemangioma however because ultrasound was atypical a follow up CT was recommended to ensure stability.  Now I just had another CT scan (three months since very first CT) and it showed no change in size but still could not rule out other primary or metastatic disease. The report recommended an MRI.  But I already had one! I had a copy of this report faxed over to me (I think its better if you don't see them) I am still waiting for my doctor to call me.  He did not want to do a biopsy due to possibility of bleeding.  (Oh, I also had an RBC scan in between all these other tests but nothing showed up but this could be because it is so small) The not knowing is the worst.
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Avatar_n_tn
Hi, I just saw your information and wondered how things were going.  I've had pain in right side upper abdoment/lower chest area & have been told I have a "small lesion" on my liver. However, dr. says doesn't think lesion has anything to do with lesion. Have an appointment for recheck this Friday and am anxious, of course!
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Avatar_n_tn
Had a ct last week to check for a kindey stone because of back pain and blood in urine.  The scan came back with 2 lesions  1 in liver and 1 in kidney.  I am going for a mri with contract as soon as I can set one up this week.  Should I be worried.  My doctor is really good and said not to worry until the test come back.  It could only be a cist.
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Avatar_n_tn
Had a ct last week to check for a kindey stone because of back pain and blood in urine.  The scan came back with 2 lesions  1 in liver and 1 in kidney.  I am going for a mri with contract as soon as I can set one up this week.  Should I be worried.  My doctor is really good and said not to worry until the test come back.  It could only be a cist.
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Avatar_n_tn
Had a ct last week to check for a kindey stone because of back pain and blood in urine.  The scan came back with 2 lesions  1 in liver and 1 in kidney.  I am going for a mri with contract as soon as I can set one up this week.  Should I be worried.  My doctor is really good and said not to worry until the test come back.  It could only be a cist.
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Avatar_n_tn
I'm a 37 year old women with 3 children. I had a CT scan and ultrasound last year due to abdominal blotting. They found a lesion of about 2.8 cm said to be consistant with Liver Hemangioma. I trust my primary dr. like most of the other people on here but it did make me very anxious. I just recently had another ultrasound which showed 3 lesions instead of the one previously noted and said they are hemangiomas but based it on my previous scan. I did not have a CT scan done of the liver this time. I am a vascular ultrasound technologist so I understand how technologist dependant these ultrasounds are. Is there a change that Hemangioma's can be confused with liver cancer? I have read that hormones play a role, do you find that to be the case or is this something that doctors are still uncertain of as to how they develop and why? Am I panicking for nothing?
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Avatar_m_tn
Wow!  I am glad I read the previous notes from people with Hemangioma's.  I also have the same problem, I was having a problem with pain under the right rib cage and went in for an exam and had a unltra sound and was told I have 2 lesions or cyst in one lobe.  The doctor sent me for an MRI to detemine what they were and said Hemangiomas.  I went back 6 months later and had another test was told that I have one in the other lobe......different MRI machine.  My doctor said all test normal I am basicly healthy..........no more test except I went in comlaining of dizzie spells and he sent me for a brain scan.  He says everything normal.  I am 54 years old at the time and everything  is related to hormones.  I go to me gyno and he puts me on Hormones is this healthy for me or not?
I still have the under the rib cage pain and get sick sometimes when traveling.  I try to eat healthy and do not eat fried food.  My mother died  from cancer (what kind I do not know) it had spread all over her body before her doctors knew she had it.  She went to the doctor for regular check up's.
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