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Monitored for liver cysts. Surgery recommended for the septated cyst. Is polycystic(PLD)risk?

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Gastroenterologist, Surgical
Practicing since : 1989
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I am 62 yr and have been monitored for liver cysts first US and CT identified in 2011 June/August which also identified uncomplicated gallstones(cholesthiasis)
August 2012
US-1 subcentimeter septated liver cyst
Sept 2012
CT-showed no septation
No Hep A, B,C
complete blood count-normal
alpha protein normal
liver function enzymes tests(ALT/AST) and others-normal

Dec 2012
US- 2 sub centermeter liver cysts(old and 1 new)
No septation

XXXXXXX 2013
US- 2 old liver cysts-stable sub centimeter and 1 new septated cyst 1X0.8X1.1
complete blood count- normal
liver function enzymes (ALP/ALT) test normal
alpha protein test results-awaiting

Should contrast US be done to confirm the septation ( had done 2 CT last 2 years and early surgery recommended for the septated cyst, and other cysts?

Is this polycystic(PLD) risk ??since the first liver CT/US in 2011 say too small for characterisation but now cyst happening.

Correction
The Dec/2012 US says septated cyst in segment 5 measuring 08X1.1X1.0 cm; Cholelithiasis with tiny gallbladder polyps; slightly prominent common duct likely related to age changes but correlation with liver function test advised.

note: Liver Function test results are normal

Correction
Please ignore the US date , the ULTRA SOUND report should be 22 XXXXXXX 2013 not Dec/2012

The LFT is normal is XXXXXXX

The XXXXXXX US never mention any fatty liver whilst previous CT and US say fatty liver .

The XXXXXXX 2013 US report say(and was compared to US 28 Dec 2012):
The liver and spleen are normal in size and echo pattern. Two tiny subcentimer cysts in right hepatic lobe are stable. There is another septated cyst now seen in segment 5 measuring 08 X1.1X1.0 cm. The portal veins are patent.

There are few gallstones and tiny polyps in the gallbaldder. The gallbladder wall is not thickened. The ultrasonic XXXXXXX s sign is negative. No pericholecystic fluid is seen. The biliary tree is not dilated with the common duct mildly prominent measuring 7mm.

The visualised pancreatic head is unremarkable. The body and tail of the pancreas is obscured by bowel gas

Both kidneys are unremarkable.

CONCLUSION
1. Two stable subcentimeter hepatic cysts in right lobe. New septated cyst now seen in segment 5 measuring 1.1cm
2. Cholethiasis with tiny gallbladder polyps
3. Slightly prominent common duct likely related to age changes but correlation with liver function test advised.

May need further action

21 XXXXXXX 2013
TP/ALB/TBIL/ALP/ALT/GGT- all normal

Full Blood Count
All normal except:

RBC Count 4.47 L vs reference range( 4.5-6.3 x 10(12)/L)

Mean Platelet Volume 11.8 H vs reference range( 7.2-11.1 FL))
Posted Sun, 21 Jul 2013 in Liver and Gall Bladder
 
 
Answered by Dr. Ketan Vagholkar 5 hours later
Hi,
Thanks for writing in.
I will answers all your doubts sequentially.
1. Regarding the hepatic cysts , as they are stable, no change in size, normal liver function tests and alpha fetoprotein levels, no surgical intervention is indicated at present. Development of hepatic cysts can be a age related degenerative changes as well.
2. gall bladder with stones and polyps. Clinically as described by you , as you never had symptoms pertaining to the same you can wait and watch. Only if the stones cause symptoms ,the early symptoms being pain, nausea, increased flatulence and early satiety after fatty meals then you may require surgical intervention in the form of cholecystectomy.
3. All your other blood counts are normal so you need not worry.
I hope this answers your doubt.
regards
Above answer was peer-reviewed by
 
Follow-up: Monitored for liver cysts. Surgery recommended for the septated cyst. Is polycystic(PLD)risk? 4 hours later
Hi Doctor XXXXXXX
Many thanks.

1. What about the latest XXXXXXX 2013 US which says a NEW segment 5 0.8x1.1x1 cm septated cyst on top the two previous stable cysts? I am concerned about this new septated cyst- which I read over the internet- can be suggestive of ... I am thinking of asking for a repeat US but on contrast basis as a confirmation to see whether there is really septation, irregularities or debris, hyper-vascularities if any. I had done 2 CT already(2011 and 2012) , so that's enough. Maybe MRI, but I read it has no role in determining septation.

In Aug 2012, US showed a subcentimeter Septated cyst which CT in Sept 2012 says there is no septation nor any hyper vascularities nor any suspicious lesions. Again , in Dec 2012, a follow-up US did not see any septation but picked a new subcentimeter cyst. These 2 old cysts are stable.

Hope , we are on the same page regarding cysts.

2. I am awaiting my XXXXXXX 2013 alpha fetol protein test results. But my latest XXXXXXX 2013 Full blood count and LFT are normal. My LFT and Lipid profile test have been normal since XXXXXXX 2012

3. Based on the XXXXXXX 2013 US, do you see any fatty liver. My earlier US in 2011, 2012 all say there is fatty liver. But I went on a strict diet of vegetarian and fish only(NO RED MEAT) since Aug 2012. I lost 12kg since.

Thanks again
 
 
Answered by Dr. Ketan Vagholkar 18 hours later
Hi,
thanks for the feedback.
1. Development of cyst in the liver which are uncomplicated and asymtomatic are usually degenerative in etiology. If contrast enhanced CT does not show any vascular features then the chances of malignancy is very less. The other possibility is cystadenomas. But in your case the Ct does not reveal any sessile or pedunculated masses within the cyst.So this possibility is ruled out.
2. A normal alpha fetoprotein will reduce the chances of it being a hepatoma.
3. The recent Ct does not reveal any fatty liver as per your description. Irrespective of the report you can still take a course of liver tonics such as ornithine compounds which will resolve the issue as well as improve liver function.
I hope this answers your query.
Regards
Above answer was peer-reviewed by
 
Follow-up: Monitored for liver cysts. Surgery recommended for the septated cyst. Is polycystic(PLD)risk? 3 hours later
Hi Dr
Thanks

Just to make it my comments on your reply:
1.The recent Ultra Sound XXXXXXX 2013(which you have) shows a new septated NEW Cyst in segment 5 right lobe. The other two old cysts are not septated. I have not gone for CT this year and I don't think I wish to do another CT because I had done 2 already ; one in 2011 and one in Sept 2012. The Sept 2012 CT (not enhanced) did not see any vascularities in the old cyst or suspicious lesions(only one cyst then that was suspected septated by Ultra Sound done in Aug 2012)

The Sept 2012 CT says
Quote
A few subcentimeter nonenhancing hypodensities are seen again in both hepatic lobes, the largest in segment five measuring about 9mm. These are too small for characterisation but are stable from previous CT study(Sept 2011) and are likely cysts. ...No suspicious contents or thich septations(septations are better seen on ultra sound study). No hypervascular or enhancing solid lesions are identified. Hepatic and portal veins are patent.


So your comment makes reference to my recent Ultra Sound XXXXXXX 2013 and NOT to CT(no 2013 CT done yet)
quote
But in your case the Ct does not reveal any sessile or pedunculated masses within the cyst.So this possibility is ruled out.
unquote

Not sure the recent Ultra Sound('US') or any US can see this. Please comment if you think the XXXXXXX 2013 US confirms your point.

My main concern is whether septated cyst(NOT a simple cyst) found on the recent XXXXXXX 2013 US can be a false positive as had happened in August 2012 US but that cyst was not confirmatory by the Sept 2012 CT(see above).

2. Noted . I will be able to know the alpha fetoprotein test results very soon. My Full blood count done this month are all normal; otherwise it will show in the alpha protein. My ESR done in Feb 2013 was also normal.

3. Again , there is no '...recent CT...' just an Ultra Sound study done in XXXXXXX 2013(this month). Again can you confirm the XXXXXXX 2013 US does not reveal any fatty liver?

4. Your conclusions: Given the NEW septated segment 5 cyst identified in recent US XXXXXXX 2013 and the information you have, would you recommend: a) New septated cyst: Not a concern ; do nothing but wait and see and take liver tonics? or b) other action steps ?
 
 
Answered by Dr. Ketan Vagholkar 3 hours later
Hi,
Thanks for the feedback.
As the size and physical features of the lesions are stable or the same you need not worry. Ultrasound is not the final investigation for liver. It may be suggestive but is not confirmatory. Contrast enhanced Ct is the final test. If that does not reveal any suscpicious features you need not worry at all.
I would suggest await and watch policy accompanied by liver tonics for the time being.
I hope this clarifies your doubt.
Regards
Above answer was peer-reviewed by
 
Follow-up: Monitored for liver cysts. Surgery recommended for the septated cyst. Is polycystic(PLD)risk? 8 hours later
Hi Dr
As I had done 2 Ct already in the 2011 and 2012, it is clearly not wise to repeat.

It would be prudent to investigate further any suspicious features for the new segment 5 septated 1.1mm cyst identified by the recent 2013 XXXXXXX US, either by biopsy or MRI or enhanced contrast Ultra sound? No point delaying.

My experience in 2012 tells me so as the August 2012 septated cyst turns out to be a false positive by subsequent Sept 2012 Ct .

Would you agree?

 
 
Answered by Dr. Ketan Vagholkar 10 hours later
Hi,
As the new lesion which you have described is cystic and is too small you need not worry. The chances of it turning out to be malignant is very less. You can follow a wait and watch policy.
If still you have doubts then a contrast enhanced Ct followed by Ct guided FNAC could be done.
I hope this answers your doubt.
Regards
Above answer was peer-reviewed by
 
Follow-up: Monitored for liver cysts. Surgery recommended for the septated cyst. Is polycystic(PLD)risk? 3 hours later
Hi Dr
The new cyst is SEPTATED and not a simple cyst per XXXXXXX 2013 US .

I don't think it is wise to go for Ct as had done 2 previously; as I had reiterated. Too much radioactivity.

What do yo u think of MRI or Contrast Enhanced Ultra Sound to define the Septated cyst properly?

 
 
Answered by Dr. Ketan Vagholkar 13 minutes later
Hi,
The chances of a septate cyst being malignant is very less.
If one wishes more clarity on it then a MRI would be advisable. But in the context of liver lesions Contrast Ct has excellent sensitivity and specificity in picking up even small lesions. I hope this answers your doubt.
Regards
Above answer was peer-reviewed by
 
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