My liver elastogram has revealed a large mass of 19.8 to 10 cm, with increased reflectivity in the liver's right lobe, also confirmed in the CT scan. Though presently do not have any symptoms, but worried about feeling weak and having weight loss. I was diagnosed with fatty liver five years ago. I am also having high blood sugar and high blood pressure.
Welcome to icliniq.com.
Well, I can completely understand your anxiety and worry. And to be very honest, I cannot tell the next best treatment approach to this liver mass unless we confirm it with the biopsy of the mass and fully understand what we are dealing with. The treatment can then be guided easily. I have seen all your reports which you have uploaded (attachment removed to protect patient identity).
The CT (Computed tomography) scan has confirmed a large mass in the liver, which suggests two possibilities.
Some features in the CT scan suggest the former diagnosis, and some suggest the later diagnosis.
The best investigations would be a biopsy of this mass under ultrasound guidance to confirm what it is.
I acknowledge that you had the fatty liver disease in the past, but looking to your CT scan, it does not show any evidence of liver scarring (liver fibrosis or cirrhosis).
I must tell you the liver elastogram is the least helpful test in all of the difficulties you have done because it is usually performed to see the liver stiffness and rule out fibrosis/cirrhosis and never helped diagnose the mass lesion in the liver.
So the best next step is a biopsy of the mass with the help of ultrasound guidance. Once we have the biopsy report available, a further decision can then be taken.
Meanwhile, I want you to get some blood tests; they are tumor markers, which would give us a clue about whether there is any trace of the tumor in other body organs.
I also want you to tell me about the following things. This will help to establish the source of the tumor in other organs of the body.
Let me know the above things. And get the testing, which I suggest below.
Metastatic liver disease versus primary hepatocellular carcinoma (HCC).Investigations to be done:
Carcinoembryonic antigen (CEA) levels.
Serum Chromogranin A levels.
If you have any altered bowel habits, I suggest you discuss colonoscopy with your gastroenterologist there. Otherwise, it would help if you waited for the above testing to come, and then we will decide.
Please update me about your other symptoms.
Thank you for your reply.
The patient does not smoke, is not experiencing a change in stool color, shortness of breath, cough, or any swelling elsewhere. As advised, have given samples for tests suggested by you. However, I have received some additional test reports, including AFP.
Antinuclear antibodies are positive and autoimmune hepatitis has markedly increased AFP is 579.
Please advise the best course of action. We will try to upload the other test results also.
Welcome back to icliniq.com.
Thank you for providing further information about your case and the tests (attachment removed to protect patient identity).
So with raised AFP (Alpha-fetoprotein), it is highly likely that it is primary hepatocellular carcinoma (HCC).
But I must tell you that your case is a little tricky. Because the radiology report (CT scan) has not been helpful as it is in usual hepatocellular cancer cases, if the CT scan report has been conclusive, we probably would not have been in this discussion anymore. We would have labeled that this is HCC and would have now been discussing the further management plan. But this is not the case.
Note: AFP can rise in non-HCC cases. Such as in certain tumors of others can spread to the liver and start secreting AFP mimicking like HCC.
The best next option is to do a biopsy of this large mass in the liver with ultrasound guidance while awaiting the reports of tumor markers that I have suggested to you earlier. For a liver biopsy, do consult your hospital radiologist.
Was this answer helpful?|
Query: Hello doctor, I had some concerns regarding asbestosis. Approximately 10-11 years ago, I worked on a building site. I was asked to remove some insulation off a water pipe in an attic. At that time, I asked the site manager if the insulation was asbestos and he said it was not. I also took a sample o... Read Full »
Query: Hello doctor, I want to ask about my father. He is too ill. His doctor told us about a hepatoma in his liver and the liver is enlarged. Now, kindly tell me the treatment. The doctor said about chemotherapy but we did not agree for it. Read Full »
Query: Hello doctor,I feel pain on the left side of my chest. I have no sugar but high blood pressure. My age is 50 years. I am 67 inches in height and my weight is 78 kg. Read Full »
Ask your health query to a doctor online?Ask a Medical Gastroenterologist Now