Uncertain Liver Nodules: What You Need to Know - Gastroenterology and Hepatology

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There are unknown nodules in the liver. After the CT scan, the doctor is also unable to determine whether they are benign or malignant. I am very scared?


There are unknown nodules in the liver.
After the CT scan, the doctor was also unable to determine whether they are benign or malignant.
I am very scared.
Hello, Dr.
Hsu.
I have long admired your reputation.
I am currently 31 years old, 175 cm tall, and weigh 80 kg.
During my health check-up two years ago in April 2002, the results were as follows: Hepatitis B surface antigen (HBsAg) = 0.7 (Negative), antibody to Hepatitis B surface antigen (Anti-HBs) = 0.00 (Negative), antibody to Hepatitis B core antigen (Anti-HBc) was not tested, Hepatitis C antibody (Anti-HCV) = 1.22 (Positive), and alpha-fetoprotein (AFP) was not tested.
GOT = 17, GPT = 14, indicating mild fatty liver.
At that time, the doctor warned me of a suspected past infection with Hepatitis C.
I immediately went to the municipal hospital the following month in May 2002 to retest for Hepatitis C, which was negative, and an ultrasound also showed normal results.
Fast forward to my health check-up six months ago in November 2003, there were no recorded values for Hepatitis B.
Anti-HCV = 0.34 (Negative), AFP = 1.48 (below 20), albumin = 4.8 (normal range 3.5-5), total bilirubin = 0.8 (normal range 0.1-1.2), alkaline phosphatase = 114 (normal range 66-220), GOT = 21, GPT = 26, indicating mild fatty liver.
At this time, Hepatitis C was still negative, but the ultrasound technician measured a liver nodule at 1.1 cm x 2.5 cm, suspecting a localized area without fat or a hemangioma.
This was six months ago in November 2003.
I understand the concepts of localized areas without fat and hemangiomas.
In March of this year, a follow-up ultrasound showed that Hepatitis C was still negative, and the nodule measured about 1 cm x 2.5 cm.
Last week, during another follow-up ultrasound, Hepatitis C remained negative.
The doctor made an effort to measure the largest dimension, which was nearly 2 cm x 2.5 cm.
AFP = 1.12, and GOT/GPT were both at 22 and 26.
When I asked the doctor if the nodule had grown, he took me to review the images and explained that measurement discrepancies could occur due to the angle or tilt during measurement.
The doctor exerted effort to find the maximum size, resulting in 2.0 x 2.5 cm.
He then compared the ultrasound images from six months, three months, and two weeks ago, showing sizes of 1.2 x 2.5, 1.8 x 2.1, 1.6 x 2.2, and the most recent 2.0 x 2.5 cm, while stating that it appears there has not been significant growth or change.
I have several questions:
1.
I am very worried about whether the nodule has grown in the past six months.
I hope the 1.1 cm measurement from six months ago was incorrect.
My long-term health check reports indicate that I do not have Hepatitis B or cirrhosis, but there seems to have been a false positive for Hepatitis C.
I am very concerned that this nodule could be liver cancer.
2.
General information suggests that liver hemangiomas are congenital.
However, in my case, they were not detected on ultrasound two years ago (the following month in May 2002, the municipal hospital also found nothing).
The nodule was discovered a year and a half later in November 2003, measuring approximately 1.1 cm x 2.5 cm.
Is it possible for a hemangioma to develop later in life?
3.
I was suspected of having a Hepatitis C infection two years ago, but subsequent tests have all been negative.
Is there a possibility that I contracted the virus through acupuncture (I recall having a stiff neck and receiving acupuncture treatment)? Could it be that the virus was eliminated from my body later, resulting in all subsequent tests being negative? Is there a possibility of a latent carrier state for Hepatitis C, or could it be undetectable after recovery?
4.
In the CT images, part of the nodule appears bright due to the contrast agent, while other parts are faint and similar to normal liver cells.
The doctor kindly explained that if it were a hemangioma, it would all appear bright after contrast administration, indicating vascularity.
If it were liver cancer, the remaining parts would appear very dark.
However, in my case, one image shows brightness while the nodule appears faint like normal liver cells, making it difficult to determine.
The doctor mentioned that most tumors are filled with arterial blood vessels, which would show as completely dark on CT.
Is it possible for a tumor to not appear completely dark?
5.
The doctor kindly mentioned that he would present my case at a meeting to discuss with other physicians.
What does this generally indicate about the situation? Could it be serious?
6.
Hemangiomas typically present as areas of high echogenicity, correct? Is there a possibility of heterogeneous high echogenicity in hemangiomas? I understand that liver hemangiomas have a higher distribution of venous blood vessels and residual contrast agent, leading to bright areas.
Would they appear uniformly bright?
7.
There is an adjacent area of uniform dark gray.
The doctor quickly stated that it was a non-fatty area, but he was uncertain about the nodule.
The ultrasound appeared to show something concerning, but the CT showed vascular bright spots.
He suggested an MRI for further evaluation and mentioned that he would discuss it with other physicians.
The CT report also stated that it could not determine whether it was liver cancer or a benign nodule.
8.
I am under a lot of mental stress, unable to sleep at night, and I don't dare to tell my family.
I am reaching my limit.
The information available outside is mostly about blood test reports, and only doctors can interpret the images.

This is my situation, and I sincerely request your response for reference.
Thank you.

Beitou Ren, 30~39 year old female. Ask Date: 2004/07/03

Dr. Xu Jinchuan reply Gastroenterology and Hepatology


Hello, Beitou resident! Your question has already been logged in our discussion forum, and we understand that the tests you have undergone so far have not provided you with a clear answer.
We do not oppose your decision to seek a detailed evaluation from another hepatobiliary specialist.
Regarding your concerns, many of them are based on imaging reports, which can be difficult to explain clearly in writing; it is essential to see the images in person for accurate interpretation.
As you mentioned, you would like to visit National Taiwan University Hospital.
You will need to make an appointment first, and at that time, you can bring a copy of your current reports to help the physician quickly understand your situation.

Reply Date: 2004/07/03

More Info


Understanding uncertain liver nodules can be a daunting experience, especially when faced with the possibility of malignancy. It’s important to approach this situation with a clear understanding of the medical context and the implications of your test results.

Firstly, the presence of a liver nodule, particularly one that is uncertain in nature, can be concerning. However, it’s crucial to remember that not all liver nodules are cancerous. In fact, many are benign conditions such as hemangiomas or focal nodular hyperplasia. Your medical history indicates that you have undergone multiple tests, including ultrasounds and CT scans, which have shown varying results regarding the size and characteristics of the nodule.

1. Nodule Size and Growth: You expressed concern about whether the nodule has grown over the past six months. It’s important to note that measurement discrepancies can occur due to factors such as the angle of measurement or the technician's technique. Your physician’s reassurance that the nodule does not appear to have significantly changed is a positive sign. Regular monitoring through imaging studies is a common practice to assess any changes in size or characteristics over time.

2. Hemangiomas and Development: Regarding the possibility of a hemangioma developing after previous normal ultrasounds, it is indeed possible for benign lesions to become more apparent over time. Hemangiomas are vascular lesions that can sometimes grow larger or become more visible with imaging as they develop. They are typically congenital, but their size and visibility can change, leading to new discoveries during routine imaging.

3. Hepatitis C and Testing: Your history of a positive Hepatitis C antibody test followed by negative results raises questions about the possibility of a false positive or a transient infection. It is known that some individuals can clear the virus spontaneously, leading to negative tests later on. However, the absence of detectable virus in subsequent tests is reassuring. Hepatitis C can indeed have a latent phase, but if you have tested negative multiple times, it is unlikely that you are a carrier.

4. CT Imaging Characteristics: The interpretation of CT imaging is complex. The fact that part of the nodule enhanced with contrast while other parts did not can indicate a benign process, such as a hemangioma, which typically shows uniform enhancement. Malignant tumors often exhibit irregular enhancement patterns. Your physician's comments about the imaging characteristics are important; they suggest that the nodule does not exhibit classic signs of malignancy.

5. Multidisciplinary Discussion: The fact that your case is being discussed in a multidisciplinary meeting is standard practice in many medical institutions. This approach allows for a comprehensive evaluation of your case by various specialists, which can lead to a more accurate diagnosis and tailored management plan. It does not necessarily indicate that your condition is severe; rather, it reflects a thorough and careful approach to uncertain findings.

6. Characteristics of Hemangiomas: Hemangiomas typically present as well-defined, hyper-echoic lesions on ultrasound and can show significant enhancement on CT due to their vascular nature. However, they can also exhibit heterogeneous characteristics depending on their size and composition. Your description of the nodule's appearance suggests that further imaging, such as an MRI, may be warranted to clarify its nature.

7. Emotional Impact: It’s completely understandable to feel anxious and stressed about your health. The uncertainty surrounding liver nodules can be overwhelming. It’s important to communicate your feelings with your healthcare provider, who can offer support and possibly refer you to a counselor or support group if needed.

In conclusion, while the presence of an uncertain liver nodule can be concerning, many factors suggest that it may not be malignant. Regular monitoring, further imaging studies, and a multidisciplinary approach to your case will provide the best pathway to understanding your condition. Remember to take care of your mental health during this process, and don’t hesitate to reach out for support from friends, family, or professionals.

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