lesion hepatic dome

[cc&company]

I am a 42 y.o. female, 2 years ago was taken to the ER with severe abd pain-fainting..diagnosis 10cm mass in abd, along with bleeding right ovary.  ovaries removed and mass turned out to be a 10cm blood clot removed also. This was not sudden-I had been suffering from severe nausea and had lost about 25 pounds before this happened. I was placed on an estrogen patch before leaving the hospital. since then have had 5 benign tumors removed from breasts 2 on left and 3 on right. last one was largest and although benign was dignosed with atypical ductal hyperplasia.  Have since seen an oncologist to follow with and am taking Tamoxifen for ADH, but was told to no longer take estrogen.  At the time all this happened I had a CT scan of abd. that also showed a very small lesion on my liver, Rad. at the time felt was insignificant.  I had another CT a few weeks ago due to pain in my right upper quad, usually nagging sometimes more severe than others.  Lesion had grown from 7.4mm to just over 1cm, my pain is right under my ribcage. I can always feel it and have even had to shift my weight when driving to my left side to relieve pressure on right side.  US showed good looking liver but they could not visualize lesion as it is very high on hepatic dome.  no gallstones. pcp ordered bloodwork inc., LFT's, CA19-9 and CEA but no AFP. labs ordered were normal.  RBC tagged study was inconclusive due to the size of the lesion. Rad. is suggesting close follow-up CT scan in 3 to 6 months. Surgeon thinks highly suggestive of hemangioma due to slow growth but is apprehensive to biopsy due to bleeding.  I am wondering if it is a hemangioma, if growth could have been caused from 2 years of estrogen patch use or from app.1 mo. of tamoxifen use, oncologist thinks Tamoxifen cause is unlikely.  Is there any other difinitive test to show hemangioma-vs-tumor? thoughts on PET scan? should I ask for AFP? or possibly a different blood test? I also had a HIDA scan which was inconclusive also for my pain.  No one can give me any definitive answers, I am very concerned.  Should I continue with Tamoxifen or d/c it until lesion is identified? I am tired of tests but also want to make sure i am ok.  Surgeon seems to think that lesion is not causing my pain--I think it is.....what do you think?  if lesion has grown again on next CT what would you suggest? Since I have gone through bleeding in abd before i worry about this also, what is the chance of this starting to bleed ?  I also, have a huge family history of cancer, including bladder, lung and liver (grandparents), so you can see my reason for concern.  Recently, I have been having lots of lower back pain and pelvic pain, not new but worsening, any correlation?   thanks so much for your time.  C.C.

[Kevin Pho, MD]

Further imaging of a hemangioma can be done with an MRI.  This may be helpful in differentiating between a tumor vs hemangioma.  

Another option would be a pooled red cell study.  This can be helpful if the imaging studies are non-revealing.

I cannot make any recommendations about the Tamoxifen until the lesion has been defined.  

At this time, serial imaging studies are reasonable to determine growth.  If the size remains stable, then the lesion can be watched.

You can discuss these options, particularly the MRI study, with your personal physician or in conjunction with a GI specialist.

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.
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