Hello doctor,I started having right sided pain in the rib area around one year and three months ago. It got really bad last week and I went to a doctor. They did an ultrasound and found several hyperechoic nodular foci on the liver. He said this could simply represent hemangiomas but could be mucinous metastases. I started panicking as I have always had bad health anxiety. I went to get a CT scan and could not do a contrast so found well defined "mildly hypodense mass" measuring 44.6x32.9 mm. I started to get really bad - not sleeping, not eating, losing weight, bad headaches, ringing in ears, muscle twitches, shaking, etc. They scheduled me for biopsy and when I got there the surgeon said they pulled up my old CT from six years ago and the mass had not changed. So, it was most likely hemangioma and not going to do a biopsy.I still kept on the downward spiral as I did not believe them. I was told an MRI with contrast was the best test for liver lesions so I paid and had that done. Also had a brain MRI done because I thought I definitely had stage 4 cancer. All of this was one year back. MRI showed multiple liver lesions with largest 30.5x23.9 mm. T2 hyperintense and several others. All identified as behaving as hemangiomas and simple cysts. Not being satisfied with that I had a colonoscopy and upper endoscopy done. Both alright. Decided to go to liver specialist and they did another MRI with 9 cc Multihance. Findings were all clear except liver with "multiple lobulated T2 hyperintense hepatic lesions" largest being 3.1x2.5 mm. All consitent with hemangiomas. "No suspicious hepatic lesions".The specialist also told me if I had stage 4 I would be in very bad shape with no treatment. I started back working out and put all my weight back on up to 200 lbs and feeling better except same pain in right side rib area every day. Got another six month follow up MRI last month and nothing had changed. Last week, I started having pain again in right rib area and started internet searching again and finding most hemangiomas are single not multiple and most metastases are multiple, which mine are. Also that hemangiomas are mostly in women not men. So now I am back to not sleeping, not eating, and feeling like I have some type of stage 4 cancer. Never had any cancer diagnosis though and none in my family. Eat good, worked out twice a day, only drink water, maintain a healthy weight. Even though I know in almost a year and a half with no treatment and stage 4 I would be bad shape or actually dead as the average lifespan of stage 4 metastases without treatment is 8.7 years, but I do not really believe that because they are not oncologists. I looked up and saw that NET's could be slow-growing cancers and maybe I have that. I just need an independent second opinion on what could cause right side pain besides what is showing up in all the tests I have had done. Also if having three MRI's with contrast saying the same thing is specific enough to rule out liver metastases. Online it shows MRI with contrast has a 97 % specificity when done one time so is three times even better to rule it out? Why would a male in great shape otherwise develop hemangiomas throughout the liver? Would a PET scan be better than MRI at this point? Thanks.
Hello. Do not worry and do not panic. All your reports (attachment removed to protect patient identity) are pointing towards hemangiomas. It is easy to differentiate between cancer and hemagioma by a radiologist on CT scan, MRI, or ultrasound. Your reports are clearly indicating cystic lesions (hemangiomas). If these liver lesions were cancerous, usually they will be symptomatic - progressive weight loss, poor appetite, jaundice and deranged liver function tests, sometimes dark urine, etc. Any cancerous liver lesion will progressively increase in size. Even slow-growing metastatic neuroendocrine in liver is usually stage 4 neuroendocrine tumor. Your blood report is showing normal liver parameters, CT scan/MRI showing cystic/hemangiomas in liver. Any radiologist can easily differentiate between hemangioma and metastasis. So, your radiologist has mentioned clearly benign cystic lesions. Also, you have no weight loss, poor appetite, and your liver parameters in blood test are normal. Also, colonoscopy and gastroscopies are normal (there was no need to go for endoscopy). So, relax and do not worry at all. But keep following up with the hepatologist for these hemangiomas. Internet search information will confuse you. If any questions, contact me for free for one more time in the next few days. For further queries consult a medical oncologist online -->