Question: Hi Doctor, I am actually a healthy 51 years old male individual. In 2006, while doing a routine company medical test, there was an Ultra Sound done where there was a simple cyst in my liver was discovered. We got very worried and consulted several doctors as well as Liver Specialists. My LFT test were all normal. Only GGT was very high - 300. All the liver specialists after doing examining me informed that the simple cyst is nothing to worry about - especially since I have no symptoms and also since my LFT tests are all normal ( barring GGT) Still as a matter of caution, I kept doing my Ultra sound almost every 6 months just to check if the size of the cyst which was smaller than 5 cms. There was no change. Also my LFT tests were all normal. Recently in 2019, my wife reminded me to check the ultrasound since after 2010 onwards, we had not done the same. When we did the ultrasound in 2019, it showed the cyst was same : the report said : THERE IS EVIDENCE OF ROUNDED THICK WALLED CYSTIC LESION IN THE LEFT ROBE OF THE LIVER, MEASURING 3.6x3.0x0.25 CM ( VOLUME 15CC). THE CYST SHOWS ALTERATION IN THE MOPHOLOGY WITH REDUCTION IN THE DIMESNIONS AS COMPARED TO PREVIOUS US STUDY OF 2006( DONE ELSEWHERE). THE LIVER ALSO SHOWS MILD DIFFUSE FATTY CHANGES. SMALL ECHOGENIC FOCUS IN THE PERI-CHOLECYSTIC REGION MEASURING 1.4 CM IS EITHER LOCAL FAT OR HEMANGIOMA. THE INTRA HEPATIC VASCULAR BILIARY CHANNELS ARE NORMAL. THE PORTAL VEIN IS NORMAL IN COURSE AND CALIBRE. THE HEPATIC VEINS AND IVC ARE WITHIN NORMAL LIMITS. THE GALL BLADDER IS WELL DISTENDED WITHOUT ANY DEFINITE CALCULUS OR MASS LESION THE COMMON BILE DUCT AND PANCREAS DOES NOT REVEAL ANY DEFINITE ABNORMALITY. SPLEEN IS NORMAL IN SIZE AND ECHOTEXTURE. NO FOCAL LESION IS SEEN. The Doctor who was doing the USG informed me that there is no change and that actually the cyst size has come down because in between the cyst might have ruptured as per the Ultra sound Findings. He said nothing to worry about and I can ignore. in 2021 August 2021, I again made another USG ( after 2 years) from the same Sonography center. Doctor again mention that there was no change from last report. The August 2021 report said the below : THERE IS EVIDENCE OF ROUNDED THICK WALLED CYSTIC LESION IN THE LEFT ROBE OF THE LIVER, MEASURING 3.6x3.0x0.25 CM ( VOLUME 15CC). NO SIGNIFICANT INTERVAL CHANGE IN THE SIZE AND MORPHOLOGY FROM LAST REPORT IN MARCH 2019 THE LIVER ALSO SHOWS MILD DIFFUSE FATTY CHANGES. SMALL ECHOGENIC FOCUS IN THE PERI-CHOLECYSTIC REGION MEASURING 1.4 CM IS EITHER LOCAL FAT OR HEMANGIOMA. THE INTRA HEPATIC VASCULAR BILIARY CHANNELS ARE NORMAL. THE PORTAL VEIN IS NORMAL IN COURSE AND CALIBRE. THE HEPATIC VEINS AND IVC ARE WITHIN NORMAL LIMITS. THE GALL BLADDER IS WELL DISTENDED WITHOUT ANY DEFINITE CALCULUS OR MASS LESION THE COMMON BILE DUCT AND PANCREAS DOES NOT REVEAL ANY DEFINITE ABNORMALITY. SPLEEN IS NORMAL IN SIZE AND ECHOTEXTURE. NO FOCAL LESION IS SEEN. Again the Doctor's advice was that I can ignore. I also did my LFT test and my LFT Tests were all normal ( barring GGT which was 153. all other LFT readings were all completely normal. Now suddenly, I was seeing the internet and found somewhere that cysts can become malignant later on. So I just wanted to check and get opinion from all is where from my reports and above history, does anything look worrisome or not. I am actually an OCD patient and always have lot of anxiety related worries on health so after seeing one article in the internet, I got a bit worried and wanted to check again. Please do let me know. My only concern was that earlier in the reports in 2006/2007 and 2008 when I was doing the Ultra sound, it was sayin Simple Hepatic Cysts. But now, it says THERE IS EVIDENCE OF ROUNDED THICK WALLED CYSTIC LESION IN THE LEFT ROBE OF THE LIVER, MEASURING 3.6x3.0x0.25 CM ( VOLUME 15CC) The wording Thick Walled Cystic Lesion has made me worried that this a complex cyst and not a simple cyst and something dangerous. SO I just want to cross check and get the opinion. Otherwise I have no health issues. I just have an Anxiety and OPD Disorder for which I am taking medicines for

Dear Dr. XXXXXXX XXXXXXX

I really thank you and appreciate your kind response. This really gives huge relief to me as I had suddenly got very worried after browsing.

Just one final request - i have also attached 2 additional pdf files, the US report of 2019 and also the image slide of the latest US report of 2021.

Just to get a confirmation of being double sure - after going through these reports, if I understand correctly, even though the last 2 reports says THICK WALLED CYSTIC LESION, you say that is a medical term, but the reports suggest SIMPLE CYSTS - am i Correct ? Pls confirm again.

I was just worried with term - THICK WALLES CYSTIC LESION and started exploring the internet and saw several articles showing Complex Cysts and thought this may be different and cancerous.

So if you confirm, this will remove my worry.

Just to repeat again, I am otherwise healthy, I have no pain, no malaise, etc. When the doctor was doing my US, he kept pressing my abdomen to ask about pain, but no pain. And my LFT is also normal.

Would be grateful if you could just confirm again and I promise not to disturb you again with these unnecessary questions :-)

Ok Sir.
That helps.
But as you said, irrespective of the thick wall mentioned in the report - the indications from the reports that I have attached till now, it appears that this is SIMPLE CYST. right ? Not Complex.

Yes Doctor, I am under treatment of OCD and having medicines regularly as well......but on some occasions, certain issues trigger these OCD attacks like today's incident.
Just wanted to be sure and double/3 times sure that till now the reports from the basic UltraSounds done till now, appear that of a SIMPLE CYST and not complex cyst. That will rest my mind.