colon biopsies findings

[teach11]

My 11 year old son had a Colonoscopy and GED. The doctor didn't find any tumors but the biopsies came up with the following. Does this look serious? The colon biopsies identified in ascending and transverse regions do show mild increase in lymphocytes. within the lamina propria there is an occasional eosinophil and neutrophil. the neutrophils rarely extend into the ipithelium, and there is not crypt abscess formation. There are not architectural abnormalities and the patchiness of this process suggests a resolving self-limiting process, however, Crohn's disease cannot be excluded, but is not favored. no granulomas are identified. Architectural abnormalities  classic of idiopathic inflammatory bowel disease are not identified.I am also concerned about his liver MRI: Ultrasound showed a 1.3 cm hyperechoic lesion with possibilities of hemangioma or focal fatty deposition. the current MR does not show convincing evidence for hemangioma or focal fatty deposition. There is a 1.4 cm slightly hyperenhancing area at the posterior inferior aspect of the medial segment of the left lobe of the liver anterior to the gallbladder which is only seen on the arterial phase postcontrast images. Differential diagnosis includes trnsient hepatic intensity difference or AV shunting, or possibility focal nodular hyperplasia or hepatic adenoma. Consider correlation with alpha-fetoprotein level. This doctor doesn't seem concerned and I am freaking out. what should I do? Doesn't this sound terrible? Does Av shunting show something wrong with his heart?Also the liver spans about 17 cm in craniocaudal dimension, which is considered enlarged. My child plays basketball hard and came off of prednisone in May-high doses. He gets very winded and a side ache. I am concerned the tumor will bleed and kill him.

[teach11]

Thank you, this is helpful! I plan on going forward with the follow-up ultrasound or MRI in December--Which should we do over? I probably have a choice. Is the MRI  more precise?We plan on getting him a follow-up blood test in December for his immune system and I can request to have the blood tests added on (alpha fetaprotein and blood antibody test to rule out the Crohns.)
Is there a good teaching hospital in San Diego, or should I travel to Los Angeles? Also can you tell me what an AV shunt is in the liver?Can this blood flow problem(if it is a blood flow problem) in the liver cause him to have a heart attack while playing basketball? Should he have a heart test of some kind?
And is there something I can do nutritionally to decrease his enlarged liver? I've been buying him lots of fruit drinks.

[Kevin Pho, MD]

The colon biopsy is non-specific.  If Crohn's disease is suspected, further evaluation with an upper GI series with small-bowel follow-through can be done to further look at the small intestine.  Various blood antibody tests can be done as well to exclude this diagnosis.

Regarding the liver, the condition to exclude would be cancer.  I agree with the alpha-fetoprotein level.  This level is elevated in cases of hepatocellular carcinoma.  If a hemangioma has been ruled out, a biopsy can be discussed to further evaluate this lesion.

These options can be discussed with your personal physician.  I would also consider another opinion at a major academic medical center.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com