Liver/Adrenal Lesions on Scans

[mary colleen]

I just received the original radiology reports dating back to 9/06 from the scans done during mu husband's diagnostic period. (I'm embarrased to say that I didn't understand before joining this board that I could ask for them...)

There is mention on the CAT and PET reports of a 2 cm adrenal mass and a 1 cm liver lesion. The adrenal mass is noted as "probably a benign adenoma", and the liver mass as probably being a benign cyst, but that "an ultrasound would be needed to investigate further" (there was no ultrasound.) There was no increased uptake at these sites.

I knew all of this back at the time it happened, but I had somehow forgotten it.

As we get close to the end of my husband's chemo this month, and thus close to new scans, this is worrying me a little bit. I know that benign masses probably exist in most people, but I guess I'm concerned that these will suddenly show malignancy in upcoming scans.

Is it at all common for masses in common metastatic sites to appear to be benign in scans, then later show as mets?

Thanks

[DrWest]

If a nodule of 1 cm or larger doesn't light up on PET, it's pretty unlikely that it would be metastatic. Never say never, but benign adenomas and cysts are quite common, we now see now that so many people get CT scans for one thing or another. And PET scans do a good job of distinguishing benign things from malignant things, at least once they get to a centimeter or more.

[mary colleen]

Dr. West - Thank you! I do understand the "never say never" part, but still greatly appreciate the clarification of probability. I think the specter of chemo ending and upcoming scans just began to overwhelm me. Thanks!

[hockeyma]

We don't seem to have the access to this PET scan that I have heard of yet in Ontario. My husband has CT scans and ultrasound on his liver and they come up described as echogenic nodules - whatever that is to mean. He used to drink alot(like 2 24's per week) of beer so nothing tells me that maybe these aren't from that....maybe wishful thinking. If PET scans tell malignancy and ct scans don't does that mean that to be sure what is and what isn't malignant with him has to be biopsied - cause there would be a pile of biopsies required. Any thoughts anyone? Also he has some mass in his kidneys with ring enhansements - and lesions. It appears that mets in the kidney aren't that common with lc - anyone know how true this is?

Heather

[Don M]

I always have structures show up in my liver that were characterized as lesions in the ct scan report. A PET scan always shows no uptake, so I don't worry about it. They have been noted since 2003. I also had an ultrasound that identified two echogenic cysts in my liver, but the PET scan never picked them up. That was in 2003 also. I have had numerous PET/CT scans since then and they are not remarked on. They may be hematomas, benign.

I never had my liver biopsied just to make sure. I have heard of one person who had mets to the kdney from lc. Perhaps your husband should travel to a province that has a PET/CT scanner and investigate. I always thought that slicing and dicing my lung was good enough. If the PET scan shows no malignacy anywhere else, that is good enough for me and apparently the docs were satisfied too.

Don M

[DrWest]

Heather,

PET scan would be helpful to confirm (if no uptake in those lesions, it's very unlikely they're cancer); the term "echogenic" suggests that those lesions have liquid in them, which is more consistent with benign cysts. Those are pretty common. If there's question either because a PET can't be done or there's ambiguity after the PET, biopsy could be done on one of those lesions, and it would be reasonable to presume that they are all the same process, so just biopsying the most accessible one would be fine. But if there isn't a lot of suspicion, it's fair to just follow them on scans -- you'd expect them not to change over time.

As Don indicated, kidney metastases are seen from time to time but are an unlikely place for LC to spread.

[hockeyma]

Thank you Don and Dr West

Ger gets new CT scans on Monday and results withing a couple of weeks. That may tell more on the liver lesions. As far as the kidney mets - I think that is probably why two separate doctors both want to re-analysize the biopsy for possibility of thyroid as primary or a second primary. My husband just couldn't be normal - nor has he ever been!

It will be interesting to find out - just hoping right now that the past 4 cycles of chemo has made a difference.

Heather

[mary colleen]

Heather,

Good luck to you both on those new scans!