liver lesions

Hello, This is in followup to the post I made on 2/1/07 titled "non-specific liver lesions" I am 41y/o wf. Non-smoker, non-drinker. I have had so many tests done recently that it is becoming very frustrating.Most recently an MRI. It showed basically the same thing as the CT scan did. impression: In the abscence of primary malignancy I suspect these lesions are focal nodular hyperplasia or possibly adenoma, recommend followup with CT in 3-6months. Everything else seems WNL in my abdomen. The diagnosis seems very vague to me. Do they not know what I've got? I now have to have a liver/ spleen scan. (don't have a clue what that is) My Dr. has discussed this with several other physicians and they think I will have to have these removed. From what I have read you don't need to remove FNH. What do you think and why would they be pushing  surgery just to get a diagnosis? My Dr. said a liver biopsy would be too much risk for bleeding. Would the risk be less for surgery? Is this considered a major surgery or can it be done laproscopic? I have also had liver enzymes, a CEA, and an AFP drawn. All were normal.
  I do have symptoms of something, nausea, gas etc. It is not intolerable yet. My hida scan showed a EF of 34%. Could that cause these symptoms? Any advice would be appreciated

[Kevin Pho, MD]

Imaging studies cannot give a definitive diagnosis - it can only be suggestive.  Obtaining liver tissue via removing the lesions or biopsy can give the most definitive diagnosis.  

Larger and symptomatic adenomas should be surgically removed.  The risk of a transformation to cancer, bleeding or rupture all come into play with a larger lesion.  

Discussion of the case with a surgeon should be done.  I cannot comment on whether it can be done laparoscopically without reviewing the record.  

A low gallbladder EF can lead to the symptoms as well.  If this is suspected, removing the gallbladder may help.

These options can be discussed with your personal physician or hepatologist.

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.

Kevin, M.D.
kevinmd_

[taffeyee]

Hi your post described my problem!  About 5 years ago I went through the same thing only the pain regestered 10.  After seeing many doctors  we chose to remove them. It is major surgery so know all the facts before you decide to go that route. I am now back in the same position.  The liver has regenerated and so have the tumors and the pain.  Good luck I hope you find the answers you need!

[momto2]

Hi! It's good to know I'm not alone in this thing. Apparently not many people have this sort of thing. What do you mean the liver regenerated? Does that mean all your problems came back? I kind of thought once these things were removed that would be the end of it. I'm not sure if my symptoms are coming from the liver or my gallbladder. If you don't mind tell me how your situation progessed, and how was the surgery. I've never had surgery so I don't know what to expect.

[taffeyee]

Hi  I hope you have gotten more information on this.  They don't seem to know a lot about it.  I had the surgery done 5 years ago.  It is a long surgery with about 6 months of recovery.  They removed about 1/2 of the liver which contained 4 beign tumors.  There was 1 left that they could safely remove.  The liver grew back (regenerated)  and all was good for about a year.  Then the pain started again and ct scan confirmed what I knew there are tumors back and so is the pain.  The gallbladder was removed also in order to get at the liver.  A liver biopsy will help them find out more about it. I honestly can not say the surgery was worth it.  I am a 45 year old female.  I wish you the best of luck and I know it is frustrating waiting for all the test to be done but in the end I hope it helps you. If i can answer any more questions you have please ask.  Let me know how you are doing.
taffeyee

[momto2]

Hi! I'm supposed to have a surgery consult today. I'm very nervous about it. The nurse kind of suggested the surgeon could remove these laproscopically. I have 2 tumors about 2.5cm. I don't know if that is considered large or not. I received a diagram of the surgery from the office and it showed a massive incision line almost all the way across the abdomen. Did you have an incision like that? I was not happy about that picture. What did they say your tumors were? They still don't know what I have. I hope it is not cancer, that is my main concern. All my labwork has come back OK. All my other scans have been OK as well. Did you have any other previous history of liver problems? They are suggesting that tumors like these have been on the rise since women have began taking birth control pills.

[momto2]

Hi everyone, This is in followup to my previous thread. I went to the surgeons and they think I have adenomas but are not 100% sure. That concerns me a lot. Because of where one tumor is located they want to just watch them instead of removing them. I honestly have a hard time just "hanging loose" when I have LIVER TUMORS that have a chance of turning to cancer. I'm trying to get as many opinions as possible on removal of liver tumors and how that might affect my life afterwards. If anyone has an experience they would like to share please let me know!

[DesignBug]

I am 38 years old and accidentally became aware of multiple lesions (approx. 9 of them)in my liver back in Oct.06 through MRI.  (I had gone to the Dr. for abdominal pain so he ordered a CT and MRI which revealed these lesions.) It came as a surpise to find these. The radiologist was suspicious for metastatic disease. So I went to a famous cancer facility and to make a long story short they couldn't tell me what I had.  They said it could be focal nodular hyperplasia (FNH) or hepatic adenoma (HA) but they didn't know.  I had one fine needle aspiration biopsy and 4 core biopsies all which came back negative for malignancy but revealed no diagnosis of what they are. So I just had another MRI this week and it revealed that the tumors have grown and multiplied.  They are too numerous to count.  I have them in both lobes of the liver and there are new ones in the gallbladder fossa.  The largest one on the right side is 4.5cm.  I have another one that is 3cm and several that are around 1 to 1.5cm as well as numerous subcentimeter lesions.  I don't know what to think.  I believe they are benign because I would be really sick if it were cancer.  But what is making them grow and multiply?  Will they eventually take over my liver and effect my liver function?  Will I need a transplant?  How do we make them stop growing?  If resecting them doesn't help then what does the future hold?  Anyone have any comments please???  I am scheduled to see a liver oncologist in a couple weeks at a new facility.

[taffeyee]

Hi  Well i think you should have a liver biopsy done.As for the surgery scar it is quite a large  one.  It is from the middle of the breast bone and it comes downt he right side almost to the hip bone and it goes down the left side half way down to the hip bone.  I am having a lot of scar tissue infections and it is very painful.  But we are all different I have spoken to some people that have had the same surgery and they have not had any promlems.  These tumors seen to be hard to pin point excatly what they are.  I am waiting to have another scan done in about a month and if they have grown or more are found I guess I will be flying off to see surgeon again. That was also hard for me as I had to go to another provience for thr surgery and was there for five weeks before I could fly home.  It took about a year before I returned to work.  It is a long recovery.  I hope you are feeling good and try not to get stressed about it all.  Take care

[momto2]

Thank you for your input.My surgeons have decided to take a wait and see approach. I guess because the surgery can be so complicated with a lot of risk involved they decided the surgical risk is higher than the risk of these tumors turning to cancer.(of course they can't be 100% sure). I do have some discomfort but it is not unbearable yet. I am continuing to have abd. discomfort with fullness and nausea. The GI doc thinks it is not related to the tumors.Design Bug, I read somewhere about a condition called adenamatosis where you can have many tumors but I can't remember what the treatment course was. Keep me posted!

[DesignBug]

Thank you for your input.  I did read about adenomatosis.  I'll just have to wait until I see the liver specialist to get his advice on all  of this.  My concern is the growth and multiplication of the tumors in 5 months.  I don't know how fast benign tumors (such as HA and FNH) grow versus malignant (HCC). I understand how you are feeling and wish nothing but the best for you!!!

[brumosa]

A related discussion, Risks involved with multiple liver resections was started.