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multiple liver lesions/masses. Insist on surgical biopsy?
I need a second opinion if I should see liver specialist and get a surgical biopsy for 100% rule out malignancy. First here is my history: @ age 19 breast lumpectomy turned out benign. Gi problems for years suffering all led to scans that confirmed had been suffering with kidney stones for years not UTI they kept telling me. Still GI issues years pass because wouldn't do anything for me and said probably have IBS. This year age 29 currently had CT due to stones which showed liver lesions and Tarlov Cysts on spine. Finally after years of suffering GI find out with HIDA scan that it's my gallbladder. Had Cholecystectomy in April...all symptoms are gone...so thankful! Due to my dense breasts, family history of breast cancer, and previous lumpectomy had scans for breasts and found mass. Had breasts lumpectomy this May and came back confirmed per- cancerous cells. This leads me to my concern with my liver lesions, because report stated can't rule out malignancy and due to the pre-cancerous cells in breasts mass I'm very concerned I need biopsy. But would prefer surgical biopsy so they can be definite in diagnoses of the multiple lesions/masses. Below is the final report from recent MRI...please let me know what you would do if this was your wife and/or yourself in this situation. My husband and I are looking to start a family in the next couple of years and I need to make sure these are 100% not malignant or have pre- cancerous cells.
* FINDINGS
There is an enhancing mass in the posterior right lobe of the liver which currently measures 28mm where it previously measured 14 mm. This mass enhances homogeneously and is mildly hyper intense on the delayed hepatic yet phase. This pattern is suggestive of Focal Nodular Hyperplasia which has increased in size.
*Another enhancing mass is shown at the left hepatic dome now measuring 14x 20mm which is slightly smaller. The enhancement pattern and signal intensity characteristics are most compatible with Focal Nodular Hyperplasia.
*Another lesion previously seen adjacent to the right portal vein has changed in signal and characteristics. This lesion shows minimal if any enhancement and measures approximately 18mm. These lesions are not seen on diffusion - weighted imaging.
*Another tiny enhancing focus at the right hepatic dome measures 5 mm.
*6 mm subcapsular enhancing focus in segment 4 anteriorly. These very small enhancing lesions are not shown on prior study.
IMPRESSION
1. Focal Nodular Hyperplasia in the right posterior liver has increased in size.
2. Similar small focal Nodular hyperplasia at left hepatic dome.
3. Interval change in appearance of the nonspecific lesion near the right portal vein adjacent to the gallbladder fossa. This lesion no longer shows enhancement and is considered nonspecific.
4. Interval finding of 2 sub centimeter hyperenhancing lesions in the liver are also considered nonspecific.
5. Unable to rule out malignancy
6. Interval cholecystectomy
Based on this should I insist on surgical biopsy? Very concerned due to diagnosed with pre-cancerous cells already in breast mass. Also was told very rare to have multiple FNH of 4 plus and I would have 5 based on this. Also concerned of the first area they stated as FNH that has doubled...can this cause problems? Thanks you for your advice!
* FINDINGS
There is an enhancing mass in the posterior right lobe of the liver which currently measures 28mm where it previously measured 14 mm. This mass enhances homogeneously and is mildly hyper intense on the delayed hepatic yet phase. This pattern is suggestive of Focal Nodular Hyperplasia which has increased in size.
*Another enhancing mass is shown at the left hepatic dome now measuring 14x 20mm which is slightly smaller. The enhancement pattern and signal intensity characteristics are most compatible with Focal Nodular Hyperplasia.
*Another lesion previously seen adjacent to the right portal vein has changed in signal and characteristics. This lesion shows minimal if any enhancement and measures approximately 18mm. These lesions are not seen on diffusion - weighted imaging.
*Another tiny enhancing focus at the right hepatic dome measures 5 mm.
*6 mm subcapsular enhancing focus in segment 4 anteriorly. These very small enhancing lesions are not shown on prior study.
IMPRESSION
1. Focal Nodular Hyperplasia in the right posterior liver has increased in size.
2. Similar small focal Nodular hyperplasia at left hepatic dome.
3. Interval change in appearance of the nonspecific lesion near the right portal vein adjacent to the gallbladder fossa. This lesion no longer shows enhancement and is considered nonspecific.
4. Interval finding of 2 sub centimeter hyperenhancing lesions in the liver are also considered nonspecific.
5. Unable to rule out malignancy
6. Interval cholecystectomy
Based on this should I insist on surgical biopsy? Very concerned due to diagnosed with pre-cancerous cells already in breast mass. Also was told very rare to have multiple FNH of 4 plus and I would have 5 based on this. Also concerned of the first area they stated as FNH that has doubled...can this cause problems? Thanks you for your advice!
it seems unideal to slice out a part of your liver and liver function, but maybe it is necessary- I'm not a doctor
I made the mistake of not seeing hepatologist, internists seem to know nothing about the liver. an ultrasound/MRI are also diagnostic tests...
Hector,
Thank you for taking the time to respond with your knowledge of information. My breast surgical oncologist was concerned with no follow up of liver lesions, as well as myself, and primary doctor. I'm scheduled to meet with a liver specialist at the liver disease center in my local area. I'm looking foward to hopefully find comfort in knowing exactly what masses/lesions are in my liver and what if any the next steps will be.
Thanks again for your time!
Thank you for taking the time to respond with your knowledge of information. My breast surgical oncologist was concerned with no follow up of liver lesions, as well as myself, and primary doctor. I'm scheduled to meet with a liver specialist at the liver disease center in my local area. I'm looking foward to hopefully find comfort in knowing exactly what masses/lesions are in my liver and what if any the next steps will be.
Thanks again for your time!
Focal nodular hyperplasia (FNH) is the second most common tumor of the liver, surpassed in prevalence only by hepatic hemangioma. It is benign and causes no symptoms or harm. Although FNH usually has no clinical significance, recognition of the radiologic characteristics of FNH is important to avoid unnecessary surgery, biopsy, and follow-up imaging.
Malignant transformation of FNH has NOT been reported. FNH must be differentiated from a fibrolamellar variant of hepatocellular carcinoma, with which it shares imaging and gross features.
The diagnosis of FNH is achieved by use of several complementary imaging techniques. In patients for whom the diagnosis is not clearly determined with imaging findings, open biopsy or surgical resection may be needed; findings on needle biopsy may substantially overlap with those of well-differentiated hepatocellular carcinoma.[
Preferred examination
Increasingly, focal nodular hyperplasia (FNH) is being recognized as an incidental finding, owing to the widespread use of diagnostic imaging for unrelated conditions. For imaging of the right upper quadrant, ultrasonography (US) is more widely used than other modalities; usually, US findings raise the possibility of FNH. US, particularly when combined with duplex Doppler US, may be the only type of imaging required. However, further confirmation may be required, particularly in patients in whom cancer is suspected at other sites. In this setting, CT, MRI, angiography, and radionuclide imaging may be used to increase diagnostic confidence.
Limitations of techniques
The diagnosis of focal nodular hyperplasia (FNH) is made on the basis of the demonstration of a central scar; however, a typical central scar is not demonstrated in every patient. In as many as 20% of patients, a scar may not be visible. Moreover, a central scar may be found in some patients with fibrolamellar hepatocellular carcinoma, hepatic adenoma, or intrahepatic cholangiocarcinoma. This limitation applies to all cross-sectional imaging techniques, including US, CT, and MRI.
If you are still worried see hepatologist at a liver transplant center. Doctors in radiology there tell the difference between different types of lesions on a daily basis. They are the experts.
All your lesions very small. Possibly too small to diagnose. Diagnosis of liver lesions is done in the vast majority of cases using Ultrasound, CT or MRI. NOT biopsy. If it was cancer there is a possibility of spreading the cancer when a biopsy is done on a cancerous lesion.
In order to have primary liver cancer use need to have cirrhosis of the liver or be infected with hepatitis B. If you are worried that it is metastasis talk to your oncologist. Cancer that spread from other parts of the body are called by where they originate from Such as met Breast cancer. It is not Liver cancer. Liver cancer is cancer that develops in the liver itself usually caused by cirrhosis or hep B infection. It is called hepatocellular carcinoma or HCC.
Good luck!
Hector
Malignant transformation of FNH has NOT been reported. FNH must be differentiated from a fibrolamellar variant of hepatocellular carcinoma, with which it shares imaging and gross features.
The diagnosis of FNH is achieved by use of several complementary imaging techniques. In patients for whom the diagnosis is not clearly determined with imaging findings, open biopsy or surgical resection may be needed; findings on needle biopsy may substantially overlap with those of well-differentiated hepatocellular carcinoma.[
Preferred examination
Increasingly, focal nodular hyperplasia (FNH) is being recognized as an incidental finding, owing to the widespread use of diagnostic imaging for unrelated conditions. For imaging of the right upper quadrant, ultrasonography (US) is more widely used than other modalities; usually, US findings raise the possibility of FNH. US, particularly when combined with duplex Doppler US, may be the only type of imaging required. However, further confirmation may be required, particularly in patients in whom cancer is suspected at other sites. In this setting, CT, MRI, angiography, and radionuclide imaging may be used to increase diagnostic confidence.
Limitations of techniques
The diagnosis of focal nodular hyperplasia (FNH) is made on the basis of the demonstration of a central scar; however, a typical central scar is not demonstrated in every patient. In as many as 20% of patients, a scar may not be visible. Moreover, a central scar may be found in some patients with fibrolamellar hepatocellular carcinoma, hepatic adenoma, or intrahepatic cholangiocarcinoma. This limitation applies to all cross-sectional imaging techniques, including US, CT, and MRI.
If you are still worried see hepatologist at a liver transplant center. Doctors in radiology there tell the difference between different types of lesions on a daily basis. They are the experts.
All your lesions very small. Possibly too small to diagnose. Diagnosis of liver lesions is done in the vast majority of cases using Ultrasound, CT or MRI. NOT biopsy. If it was cancer there is a possibility of spreading the cancer when a biopsy is done on a cancerous lesion.
In order to have primary liver cancer use need to have cirrhosis of the liver or be infected with hepatitis B. If you are worried that it is metastasis talk to your oncologist. Cancer that spread from other parts of the body are called by where they originate from Such as met Breast cancer. It is not Liver cancer. Liver cancer is cancer that develops in the liver itself usually caused by cirrhosis or hep B infection. It is called hepatocellular carcinoma or HCC.
Good luck!
Hector
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