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Dr. Andrew Rynne

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What do these following lab reports indicate?

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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1466 Questions

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Posted on Sat, 11 Mar 2017 in Cancer
Question: I had pain right side mostly and some left side off and on for about 4 months. Got bad pain right side (ribcage area) on January 4th and went to Dr. Did ultrasound and found "several hyperechoic nodular foci". Sent me for CT scan which the IV blew so it was done without contrast. Report cam back on 1/10/2017 as a 44 mmx32 mm mass. Referred me to surgeon to do biopsy and he actually had access to a 2012 CT scan that I had done for same pain, that the first radiologist did not have access to, and he did not do biopsy because he said the mass was the same as in 2012. Sent disc to radiologist who originally said it was a mass and he concurred on report dated 2/13/17 that it had not changed. In the meantime when told it was a mass I have severe health anxiety so I just shut down...not eating, not sleeping, losing weight, headaches, missing work, etc...all just since I was told I had a mass, before that I was fine physically except the pain. So I decided I wanted a brain mri because I was sure I had stage 4 cancer. Brain MRI with contrast was all clear. I then decided I wanted the best test I could have done of my liver to rule out metastases (I've never been diagnosed with any kind of cancer btw) and he said the best would be an MRI of the abdomen with and without contrast T1, and T2, DWI, with Gadavist. I went ahead an paid to have that done. My Dr. said great news and all is clear of metastases but with me reading this and searching the internet I'm just not sure I believe the radiologist or him. As the radiologist used words like "felt to be cysts"? Just want another independent opinion. I know that on Ultrasound normally metastases are hypoechoic and mine were said to be hyperechoic. And on MRI t2 "hyperintense" is supposed to normally mean no metastases as they are typically "hypointense" but I'm just trying to find out why I still have pain and so many lesions when I've also read mostly women have these? I've had chest x ray also done to see about lung masses. I've also had complete bloodwork done twice with liver function tests and tumor marker tests. I can not keep having more and more scans as I'm going crazy but this final report, even though my Dr. says is definitive to him, does not seem definitive to me but obviously I'm not a radiologist or Dr. Please help explain. I still feel pretty weak, not eating much, muscle twitches, sleeping only because I'm taking Klonopin 1mg at night.
doctor
Answered by Dr. Indranil Ghosh 2 hours later
Brief Answer:
Very much unlikely to be cancer

Detailed Answer:
Hi
Thanks for your query.

I understand your concerns. However, there is little to be worried about on these reports. The earlier post contrast CT by itself was not suggestive of cancer. It suggested hemangioma and few cysts which are totally benign. Can occur in both sexes and quite common nowadays because pretty much everybody gets scanned for some reason or other. And the recent CT, though non contrast, shows no change in the bigger lesion.

On ultrasound, metastases do appear hypoechoic. The MRI also doesn't show suspicion of metastases in you.


Tumor markers and liver function tests are normal too. Hence I don't see any real concern for cancer here.

I would suggest just clinical follow up with physician.

Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Indranil Ghosh 1 hour later
Thank you for the detailed information. just a few more questions if I may. is it accurate that the MRI I had done pre and post contrast is considered the best test to put this liver metastases in my mind all to rest? And what other things can cause the daily pain for months I've been having in my right rib cage area and around back and some on left rib area? can ibs, or gerd, or even costochondritis cause these pains? and the loss of weight, loss of appetite, withdrawn, low energy, shaking, insomnia, etc just since being told I had a "mass" would that be suggestive of anxiety or depression more than anything else? Thanks again
doctor
Answered by Dr. Indranil Ghosh 11 hours later
Brief Answer:
Yes MRI is the best

Detailed Answer:
Most likely costochondritis is the cause of pain here. And as you admitted yourself, most of the other symptoms happened after you were told to have a mass. So possibly from anxiety reaction.

As of now there is nothing to worry.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 11 hours later
also would the pancreas show up on mri with contrast clear enough as the ultrasound showed the head was clear but gas over the body and tail. I know pancreatic cancer can go to liver and the symptoms of pain with my blood glucose going up...never had diabetes...are pancreatic cancer signs. but I've had ultrasound, ct scan non contrast and mri with and without contrast and would think that pancreatic cancer would likely show up in 9ne of those? also combined with CA-19-9 and cea tumor markers being in line would that put pancreatic cancer in doubt? thank you again....
doctor
Answered by Dr. Indranil Ghosh 5 hours later
Brief Answer:
No, pancreatic cancer has been ruled out

Detailed Answer:
All the imaging and tumor markers are against a diagnosis of pancreatic cancer. So no need to worry about that.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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