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Avatar universal

Multiple types of liver lesions

I was experiencing increasing indigestion for months then a period of intense upper abdomen & back pain.  Ultrasound saw something on my liver with subsequent MRI. Results eventually came back and say ‘at least 3 types of lesion’ on my liver. Cyst 4cm high in section 7, Haemangioma 2.8cm and something which is uncharacteristic and ‘most likely’ an adenoma at 4.8cm involving the gallbladder bed.

My GP explained the cysts and haemangioma are harmless but he’s no expertise in adenoma’s and to discuss with the specialist gastro - seemed disinterested and unconcerned. From what I've read  adenoma’s are common in woman and birth control pill is often factor. I haven’t taken it for over 5 years. I still have upper ab pain, backache is also frequent and pains in right arm/shoulder/armpit.

It feels like it has already been a long road waiting for scans and tests (NHS UK) and now I have more questions than answers, such as is ‘most likely’ sufficient to be sure it’s not more sinister. In addition I am feeling worse each week. I developed an ear infection after a holiday 6wks ago, it developed into a cold, chesty cough - i cannot shake it & combined with the stomach/chest pains I am miserable. Have given up on my GP & am waiting for the specialist to discuss with me. All i've seen is what i've read on internet which gives varying opinions on surgery requirements if adenoma is confirmed.

I did have an endoscopy also - arranged privately before all of the above happened and no ulcers or other issues noted.

Would very much appreciate feedback if anyone has experienced similar.
1 Responses
Avatar universal
COMMUNITY LEADER
Welcome to the Liver Disorders community, you certain have your share of problems. And you've summarized it well. Your Hepatic Cyst and Haemangioma will simply need to be watched. Not much to worry about wrt those two. But your possible Adenoma is a different, troublesome pathology for sure. Hepatocellular adenomas (HCAs) are also known as hepatic adenomas or liver cell adenomas.

First thing to do is to get a positive diagnosis for the adenoma, if they still remain unsure at all. There are higher energy MRI machines (3T to 7T, Tesla) out there that can provide better imaging. There are alternative MRI contrasts and sequences as well that can be used along with the high energy, signal-to-noise advantaged hardware. But unfortunately, due to uncontrolled bleeding risks, liver biopsies are not an option.

The reason to make sure that the diagnosis is certain is that it allows your doctors to take on the additional risks involved with the various treatment options. If the doctors are only mildly suspicious, they'll likely be hesitant about trying the more invasive and dangerous therapies. Also, adenomas are quite rare, the annual incidence of hepatic adenoma is 1 to 1.3 per million. So they need to be sure.

You are right about the birth control pill factor. It increases the likelihood of adenomas from the 1/million rate but increases to 3.4 per 100,000 in long-term oral contraceptive pills (OCPs) and other estrogens users.

There are two primary risks with hepatic adenomas: hemorrhage and malignant transformation. HCAs are benign but on rare occasions, they will make the malignant transformation but this is very hard to detect. That's why resections make sense, in any cases that are even remotely suspicious or considered dangerous - Symptomatic tumors should be resected, regardless of size.

Hemorrhage occurred in 15.8% of all hepatocellular adenoma lesions. Rupture and intraperitoneal bleeding were reported in 17.5% of patients. The mortality rate associated with an acute hemorrhage into the peritoneum may be as high as 25-30% in patients with large tumors. In a systematic review including a total of 1176 patients, the overall frequency of hemorrhage was 27.2% among patients. Hemorrhage occurred in 15.8% of all hepatocellular adenoma lesions. Rupture and intraperitoneal bleeding were reported in 17.5% of patients.

How hepatocellular adenoma become malignant isn't well understood, and it just takes a few atypical cells to make the jump. The risk of malignant transformation is not completely known either and may be as high as 13% based on small studies. Given that OCP's are closely related tp HCA's, patients should stop using oral contraceptives or steroids. This allows for regression in the size of the majority of the tumors. Complete resolution isn't common though and the risk of malignant transformation remains even after the contraceptive or steroid use has been discontinued.

I've heard that getting a referral to a good hepatologist in the UK can be a long battle. But you need that specialist asap, so hopefully things will work out for you. Also, in addition, feel free to drop me a note if you'd like to bounce some ideas or thoughts around. I have rare issues/tumors myself so I know how lonely it can be wrt talking about things with people who have any no idea about what's really going on.

Take care and let us know how you are doing.
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