Q. My liver elastogram revealed a large mass with a fatty liver. Please help.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 23, 2020 and last reviewed on: Mar 18, 2021

Hi doctor,

My liver elastogram showed me a large mass of 10 centimeters with increased reflectivity in the right lobe of the liver. I also confirmed it in my CT scan. Currently, I do not have any symptoms but I have a feeling of being weak with weight loss. I was diagnosed with fatty liver five years back. I have high blood sugar and blood pressure.



Welcome to icliniq.com.

I understand your concern. I have gone through the reports (attachment removed to protect patient identity). Before taking a better treatment, it is necessary to do a biopsy of the mass. Your CT (computed tomography) scan has confirmed this large mass in the liver with two possibilities. The first one is metastatic liver disease. It means that there is a possible tumor somewhere in the body and it has got spread to involve the liver.

The second possibility is a primary liver tumor called hepatocellular carcinoma (HCC). It is best to do a biopsy of the mass under the guidance of ultrasound to confirm it. I accept that you had a fatty liver in the past. But your CT scan does show any evidence of liver scarring.

Usually, a liver elastogram is the least helpful test. It is usually done to recognize liver stiffness and it helps to rule out liver cirrhosis. It does not help you to diagnose a mass lesion in the liver. It is good to biopsy soon. Further decisions can be made according to the results. You need to do some blood tests with tumor markers. It gives you clear evidence of whether there is any trace of tumor present in the body organs. Kindly answer my questions to rule out the cause. Please mention whether you have a habit of smoking or drinking. Please mention whether you have any altered bowel habits or any changes in the color of the stools. Please mention whether you have any black or bloody stools. Please mention whether you have any shortness of breath or cough or chest pain. Please mention whether you have any swelling anywhere.

The Probable causes:

You have metastatic liver disease or primary hepatocellular carcinoma (HCC).

Investigations to be done:

You need to do serum alpha-fetoprotein, carcinoembryonic antigen (CEA) levels, CA19-9, CA 125, and serum chromogranin A levels. If you have an altered bowel habit, then you can do a colonoscopy after consulting a gastroenterologist.

Regarding follow up:

Please update me about your other symptoms.

Thank you doctor,

I do not smoke and I do not have any change in the color of the stool. I do not have shortness of breath, cough or any swelling in the body. I have done some blood tests. Antinuclear antibodies are positive and I have an increased AFP of 579. I have attached the reports. Please advise.



Welcome back to icliniq.com.

Due to raised AFP (alpha-fetoprotein), it suggest that you have primary hepatocellular carcinoma (HCC). Your case seems to be tricky. Your radiology report has not helped you. AFP can be seen raised in non-HCC cases too. In some cases, certain tumors can get spread to the liver causing a raise in AFP levels. The next option is do biopsy of the large mass in the liver with an ultrasound guidance. Try to do tests for tumor markers soon.

Thank you doctor,

I have done tests for serum chromogranin A, CA-125, and CA 19-9. Please go through the attached reports. I have not done biopsy till now. I have attached the reports of the ultrasound of the liver.



Welcome back to icliniq.com.

I have gone through the attached reports. Your chromogranin levels and CA 19-9 are high. It does not suggest a neuroendocrine tumor. CA 19-9 is a tumor marker for bile and pancreatic cancer. These levels are elevated and it raises a suspicion of having primary tumor within the gall bladder or pancreas. Since I cannot see any mass in your pancreas and your CT scan shows a mass in the liver, it is something adherent to the gallbladder. You seem to have two possibilities. The first one is hepatocellular carcinoma and the other possibility is gall bladder cancer which has spread to the liver. Biopsy has to be done to confirm the two strong possibilities. But the treatment is different for both the cases. The prognosis is poor in both the cases. You can treat hepatocellular carcinoma by taking Sorafenib and systemic chemotherapy can be done in the case of gall bladder cancer. But in some cases, trans-arterial chemoembolization can be done in treating HCC. It is a radiological guided procedure. So you need to do biopsy to confirm the diagnosis.

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