Liver Mass

[Sassygirl5150]

Recently went to ER with severe back pain, they did a CT scan suspecting kidney stones (came back negative).  The CT scan showed a mass on my liver though.  Dr referred me for an MRI of the liver which also confirmed the mass.  A nuclear test was also done.  The results are confusing and not sure if a biopsy is really necessary.  The GI Dr sent the report to my primary physician who was no help, as he kept contradicting himself and decided he didn't want to do any diagnosing and referred me to a gastroenterologist.  My appointment is still 2 weeks away.

The following is an email that I received from the nurse of my primary care DR (received prior to the above appointment):

'Please inform patient that CT shows a mass, and nuclear study is negative for hemangioma.  Mass is not currently diagnosed.

Per GI Dr. Advise:
"With MRI of liver:
IMPRESSION:  1.  Large lobulated left hepatic mass of approximately 7.3 x 4.5 cm but no significant enhancement.  Differential diagnosis includes adenoma and/or atypical hemangioma.
2.  Small subcentimeter cyst in the posterior segment of right hepatic lobe."
But the nuclear scan did not detect hemangioma.  Therefore, may need CAT Scan guided liver biopsy to make the diagnosis."  Patient should have discussion with her Doctor to determine if she wishes to have CT guided biopsy.'

The above seems to be contradicting as well.  Anyone else ever had results such as these?  And if you were in my shoes, would you do the biopsy?  My primary physician says that biopsies come with risks.  If the mass ends up being full of blood vessels, the biopsy may cause internal bleeding.  Please help?  I want to be armed with as much information as possible prior to going to the gastroenterologist consultation.  Very nervous about this whole situation.

Thank you,

[Sassygirl5150]

Thanks!!!!  

[fntn]

That absolutely wonderful news! Your new imaging tells them that it's a hemangioma - a benign lesion without any likely need for additional medical intervention. Also it tells them the same thing using with two different imaging technologies as well, consistent data, kind of a cross-check! And your liver shows no obvious disease, chronic or acute.

The MRI data is clean (providing sufficient data for characterization), so they can monitor it for a year or two if needed, just normal procedure, without the worries of using more radiation (CT scans) for the extra imaging, if they decide it's necessary of course.

Take care!

[Sassygirl5150]

I did get a copy of the MRI and it says "There is a lobulated mass in the lateral segment of the left hepatic lobe measuring approximately 7.3 x 4.5 cm, demonstrating low signal intensity in the precontrast T1 sequence, high signal intensity in the T2 sequence with fat suppression, and no significant enhancement in the postcontrast sequences".  The latest CT w/contrast results:  Liver is normal in size and diffusely hypoattenuating.  6.2 cm hepatic mass, left lobe, with nodular peripheral enhancement on early arterial phase and near complete fill-in on delayed phase.  Their impression and diagnosis:  "6.2 cm mass has imaging characteristics of hemangioma."  Although other radiologist says the nuclear tested negative for hemangioma.  I guess I will let this go and trust that they have the right diagnosis as hemangioma and not worry about it any longer.

[Sassygirl5150]

They did not provide me with any of that information.  I will email them to see if I can get a copy of the whole GI report.  Your questions are all new to me, I have not heard of any of those terms yet?

[fntn]

I tend to agree with your doctor. Malignant lesions tend to be very vascular and  show some enhancement during some or most of the contrast phases.

Do you know if your mass is: hypo-, iso- or hyper-intense intense ... for the T1-weighted and T2-weighted no contrast imaging sequences? Fat and fibrosis will tend to be hyper-intense in T1, Water will tend to be hyper-intense in T2, and hypo-intense in T1. Just kinda gives you hint of what your mass is partially comprised of.

[Sassygirl5150]

I forgot to mention that my primary physician seems to think that "no significant enhancement" on the scan means nothing to worry about.  Is this true?

[Sassygirl5150]

Thank you very much!  I think I am more afraid of "not knowing" than having it done, so I am leaning more towards doing the biopsy.  We shall see.  I will let you know in 2 weeks what the gastroenterologist says and we'll go from there.  Seems almost ironic how something like this is found while looking for something else.

[fntn]

I've had a bunch of liver biopsies myself to sort out this very thing. And you're right, there are a number of risks but if you have a reputable doctor and hospital, I would tend towards getting it done, if they still wish to. Most doctors will not do a liver biopsy unless they feel there is no other choice, so for them to suggest it means they're fairly concerned.

The risks include bleeding as you mentioned but there is also a seeding risk as well, if the mass is malignant. This is a very unlikely possibility but I thought you should be aware of it. I didn't experience anything bad with all of my biopsies and my main tumor is in a very tricky location. Not much pain in any of them either.

Your only other option would be to wait 3 months and then do another MRI for comparison. Good luck and let us know how it works out for you, hopefully well.