Poorly defined, hypodense, left medial segment liver lesion - Do I need to worry about cancer??

[concerned_ibs_sufferer]

34YR old Male with liver lesion. ALT at 48, above lab limit of 36; ALT was 29 6 mos ago.Dr says to do follow up CT in 3 mos. Is that all I can do, just wait 3mo to see if any growth. What if it's cancer?

9/7 CT: A 13x11mm low density lesion in periphery of inferior aspect of right lobe of liver is nonspecific but compatible with hemangioma.  A 4mm low attenuation structure in posterior right lobe of liver is too small to characterize but compatible with tiny simple cysts
IMPRESSION: Small area of low attenuation in inferior right lobe of the liver, non specific but compatible with hemangioma.  Consider confirmation of impression with focus liver ultrasound

9/14 ULTRASOUND: There is a poorly defined hypoechoic mass in left medial lobe of the liver, difficult to accurately measure but ~2.8x2x2cm. By my measurements on CT, it is unchanged in size since 9/7/10.  The liver overall shows moderate increased echogenicity, without biliary ductal dilatation.  Regions of fatty sparing are seen around gallbladder fossa.  The irregular lesion is not typical of hemangioma but may appear atypical in fatty liver setting

The smaller right posterior segment lesion described on CT is not well appreciated by sonogram, probably due to technical limitation from fatty infiltration.  On CT, this smaller lesion was more typical of hemangioma.  The 4 mm tiny lesion is not appreciated sonographically.  There is normal hepatopetal portal venous flow.  No focal tenderness or ascites is present.  The gallbladder and extrahepatic ducts are normal

IMPRESSION
1. Poorly defined, hypodense, left medial segment liver lesion, not typical of an hemangioma. More convincing imaging on CT and suspect atypical hemangioma in setting of fatty liver
2. Moderate fatty liver.  Fatty sparing around gallbladder fossa
3. Posterior segment &tiny additional lesion seen on CT are not appreciated on sonogram likely due to technical difficulties also with limited depth penetration due to fatty liver

[Thomas D Schiano, MD]

i definitely do not think this is liver cancer.  The description sounds consistent with the fatty liver and hemangioma.  i think its OK to wait without a worry.

[Thomas D Schiano, MD]

from the description this seems like a benign lesion.  You may have some fatty liver causing the abnormal ALT.  I think we just have to wait and repeat the scan--CT scan is much better than U/S.

[concerned_ibs_sufferer]

Some history for the above:  

I had gone in on 9/7/2010 for a Barium GI CT for IBS, which came up with no obstructions in the bowel.  However, the liver lesion was found incidentally, which they said from the CT seemed like it was a hemangioma. They referred me to do an ultrasound to get a definitive confirmation, but the 9/22/2010 ultrasound was less clear and suggests that it is not a hemangioma from the ultrasound.  

The ultrasound radiologist suspects it may be an atypical hemangioma in fatty liver setting, but it does not seem that he is definitive about this on the report.  I also don't know why the 9/22/2010 ultrasound report shows a 2.8x2x2 cm size hypoechoic mass  in the left lobe, while the CT lesion measurement  is ( 13x11mm) and the location is in the right lobe...So do I have 2 different lesions, one on left lobe and one on right lobe, in addition to a 4mm lesion (cyst?) on right lobe?

I'm still waiting for AFP lab test to come in...I don't know why that test result is much slower compared to all the other test results; this is making me worry more!   It seems that nothing is definitive that it is hemangioma (and thus non cancerous), so I'm panicking.  Is there nothing else I can do but wait 3 months to scan again to see that lesion has not grown?  Does that seem like an appropriate course of action?  It seems like if it is not definitive, then if I wait 3 months and it turns out the lesion has grown, then I've lost 3 months of time where we could be attacking any cancerous growth?  I apologize for all the questions...just anxious.

[concerned_ibs_sufferer]

9/3/2010 tests
Component         Your Value Standard Range
C-REACTIVE PROTEIN,SER,QL 0.1 <0.5-  mg/dL

Component         Your Value Standard Range
ESR 6 0-15 mm/Hr

Component         Your Value Standard Range
ALBUMIN 4.8 3.3-4.7 g/dL

Component         Your Value Standard Range
CALCIUM 9.9 8.5-10.3 mg/dL

Component         Your Value Standard Range
CREATININE 0.85 60 >60-  mL/min
GLOMERULAR FILTRATION RATE - AFRICAN AMERICAN >60 >60-  mL/min
COMMENT, GLOMERULAR FILTRATION RATE SEE NOTE



9/22/2010 tests:

Component         Your Value Standard Range
ALKALINE PHOSPHATASE 72 37-117 U/L

Component         Your Value Standard Range
BILIRUBIN, TOTAL 0.5 0.2-1.2 mg/dL

Component         Your Value Standard Range
ALT 48 <36-  U/L

*****My prior ALT test value was 29 on March 2010, compared to the 48 here for ALT on Sept 22, 2010

Component         Your Value Standard Range
AST 22 10-40 U/L
******My prior AST test value was 18 on March 2010, compared to the 22 here for AST on Sept 22, 2010


Component         Your Value Standard Range
NUCLEAR AB,SER,QL NEGATIVE NEGATIVE-  

Component         Your Value Standard Range
IGG 1290 600-1600 mg/dL