Found my 2005 MRI report. Someone please interpret for me!

Two lesions which were described are identified as intermediate signal intensity on T2 weighted imaging. This is not characteristic of hemangiomata. The larger lesion in the peripheral subcapsular right lobe of the liver measures approx 1.8 cm in size and in the inferior right lobe measures 8-10mm in size. There are at least three additional lesions identified on the MRI of the liver, located at the dome of the liver measuring 10 mm in size, in the medial posterior right lobe of the liver measuring 8-10mm posterior to the right hepatic vein, and just below a 5-6mm lesion peripherally in the subcapsular posterior right liver. All of these lesions demonstrate intermediate signal and are not specific for hemangiomata. Following the administration of intravenous contrast they are visualized on the first phase following contrast administration consistent with hypervascular lesions. There may be one or two additional lesions in the right lobe of the liver, which are 3-4 mm.  All of these are best seen on the first phase following contrast enhancement confirming their hypervascularity. They enhance homogeneously with no evidence for peripheral nodular enhanced hemangiomata.  The etiology is therefore confirming the possibility of hypervascular metastasis.  Other entities such as multiple hepatic adenomata is in the differential diagnosis, however, considered less likely.  If there is no source for a primary neoplasm, consideration should be given perhaps to a PET Scan for further evaluation.

IMPRESSION:  Multiple small lesions in the liver, with the largest lesion in the peripheral right lobe of the liver measuring 1.8 cm.  The lesions demonstrate a hypervascular enhancement pattern, without definitive finding enhancement characteristics of hemangiomata. Therefore, the differential diagnosis includes hypervascular metastasis, vs benign hepatic adenomata. Other differential diagnosis includes regenerative nodules although there is no evidence for portal HTN or cirrhosis.

[kingyoung]

I have Kaiser Permanente and no one EVER said anything to me after having this scan.  Actually, I found it in a sealed envelope after rummaging through a few folders.  I went back into my ongoing diagnoses w/ Kaiser and it lists... to my surprise... liver adenoma.  How did they come to this determination?  I've never had a biopsy or anything and if they are adenomas shouldn't they have been removed?

Is this RULING OUT adenomas and hemangiomas?

[Caryopteris]

They should have discussed the findings with you.  I read about it on wikipedia, and if it is an adenoma, it could bleed.  It could have been caused by birth control pills.  Maybe they were afraid you would sue.  Or maybe they did not consider you a good surgical candidate, so they didn't want to upset you.  But you should take the report to a new doctor and leave behind the one that was too chicken to tell you your results.  

[HectorSF]

The best answers will come from the doctor the diagnosed Liver adenoma.

It is difficult to follow what went on here as your first post stated that further testing needed to be performed in order to produce a diagnosis.
'consideration should be given perhaps to a PET Scan for further evaluation.'

'I went back into my ongoing diagnoses w/ Kaiser and it lists... to my surprise... liver adenoma.  

'How did they come to this determination?'  
I don't know. You didn't post the diagnosis paper?
This was 7 years ago so I'm sure a lot when on during that time.
I would ask your doctor to explain to you the diagnosis.

I've never had a biopsy or anything and if they are adenomas shouldn't they have been removed? '
Tumors are not diagnosed with a biopsy normally. They are diagnosed with different types of scans.
Adenomas are benign. There is no reason to remove them. You have been fine living with them for 7 years now.
Again your doctor is the best source of information on these questions.

Liver adenomas are uncommon benign liver tumors that develop in an otherwise normal appearing liver. They are seen predominantly in young women (20 to 44 years-old), are frequently located in the right hepatic lobe, and are typically solitary (70 to 80 percent), although multiple adenomas have been described in patients with prolonged contraceptive use, glycogen storage diseases (GSD), and hepatic adenomatosis. Adenomas range in size from 1 to 30 cm. Symptoms, such as abdominal pain, are more likely with larger lesions.

The prognosis of liver adenomas is not well established. However, they have been associated with malignant transformation, spontaneous hemorrhage, and rupture. As a result, their distinction from other types of benign liver tumors is important. This can most often be accomplished using a combination of imaging techniques, although rarely a definitive diagnosis may only be achieved following resection.


Hector

[kingyoung]

Thank you for your reply.  Perhaps they didnt want to upset me.  Who knows.  I remember that they discovered these lesions during a CT scan of my kidneys, and around the time I was diagnosed with chronic kidney disease.  Since then, CKD has taken precedence over everything else.

I guess the words hypervascular metastasis startled me.  Im no professional at reading these reports but to me it sounded like the Dr was saying that metastasis was the most likely diagnosis.

[kingyoung]

Hi,  Hector.  Thank you very much for your detailed respose!  After lurking in a few thread, i see that your presence in this forum is invaluable, honest, and reassuring.

Upon discovery of the mass(es), i had a CT scan and a red blood cell study done... all of which the Dr compared the results to prior to writing the report.  The sequence was US (for kidneys) to CT (for investigation of incidental hyperechoic liver lesion) to RBC Study and MRI of lesion.

I thought the report read that I had cancer in another part of my body that met to my liver and the MRI was pretty much confirming suspicion.... and to find the primary cancer, I would need to have a PET scan.

All of this somehow fell through the cracks, as my primary care phys never advised of the results or scheduled the biopsy. Fast forward to today, I recently went to the ER due to excruciating cycle pain for suspected adenymiosis (sp).  They did a CT scan and it noted a 1cm left adrenal mass along with few prominent retroperitoneal nodes.  Im simply hoping its not cancerous... or that ive had cancer that has gone unchecked all of these years.

I was 32 at the time of thd liver drama and had a Mirena IUD for 2 years at the time of discovery.  This has been my only form of oral contra during my adult life.

[kingyoung]

I hate autocorrect.  :(

[HectorSF]

'I thought the report read that I had cancer in another part of my body that met to my liver and the MRI was pretty much confirming suspicion.... and to find the primary cancer, I would need to have a PET scan. '

That was one of the possibilities mentioned along with benign liver adenoma and some others possibilities.

1. 'Therefore, the differential diagnosis includes hypervascular metastasis,
(A metastasis as you said of a cancer from some where else)
2, vs benign hepatic adenomata.
(Benign Liver tumor)
3. Other differential diagnosis includes regenerative nodules although there is no evidence for portal HTN or cirrhosis."
(Sometimes if is hard to tell the difference in such a small growth between a tumor and the nodules that appear on the liver when a patient has complete cirrhosis.

Since this was 7 years ago the diagnosis of  'benign hepatic adenomata' was correct otherwise the other possibilities would have had the following results.
1, If it was metastasis you wouldn't be around for long. I am no expert on all cancers but I don't know of any cancer that spread to the liver that isn't fatal with a very short time.
3. You would know most likely have very advanced cirrhosis and possibly decompensated cirrhosis which you would know about.
Have you had any ultrasound in the last few years that show nodular growths on your liver? Enlarged spleen? Port hypertension? All these are signs of cirrhosis of the liver. Also your blood tests would also has many abnormal values.
I assume this is not the case?

Does this make sense?

Best of luck to you!
Hector

[kingyoung]

Hi Hector,

Ha!  You are right, as common sense would dictate that I'd most likely be long gone if I had cancer that has spread to my liver 7 years ago.  I haven't had any follow-up scans / US of my liver since then.  And as far as I know all of my lab values for liver function have been normal.

Is Port hypertension similar to regular chronic hypertension?  or is it simply isolated to the liver?  I've had HTN and kidney disease for the last 7 years, or so.   Those lab values are another story.  

I'm wondering what is the probability of the adenomas becoming malignant? I guess I should really push for a follow up on the adenomas and the new adrenal mass.