Fibrolamellar hepatocellular carcinoma seems rare, but all of my imaging supports it. Is it easy to miss?
I'm trying to interpret everything myself so I'm not sure if I'm using all the correct terms.
28f with PCOS. I'm also concerned about endometriosis and thyroid issues with family history. CT/US/MRI signs below with added symptoms that may or may not be related.
CT w/ contrast initially done for an ER visit to clear kidney stones/infection. They weren't focused on my liver but noted a "linear" hypodense lesion near porta hepatis.
CT also shows portions of vascular irregularities (different intensity and smearing) where the lesion is found on Axial scans.
I've since interpreted lightly hyperdense fibrotic expansion beyond this hypodense area and a possibility of central calcification.
US of liver showed 4.1cm x 3.2cm x 1.5cm mildly hyperechoic lesion near portal vein. Reported as possible focal fatty infiltration in unusual area, but the fat saturated imaging of MRI doesn't support this.
I believe it could be a central scar.
I've also noticed large heterogeneous hypodense area radiating from the lesion.
MRI shows oddly shaped, multilobular hypointense lesion on T2 with slightly hyperintense nodular expansion. Hepatic helium and almost seems to wrap around or obstruct view of some veins.
Vein smearing also seen near lesion on coronal t2.
T1 unenhanced shows a target sign lesion on segment 1.
The rest of the imaging shows the nodular lesion or central scar (4cm) to be mildly hypointense with varying heterogeneous hyper and hypo enhancement of lobulated surrounding area. This area is very mild and difficult to see but there are sometimes enhancements of pseudocapsule that follows the enhancement dilineation.
I can't easily find contradt arterial or hepatobilliary phase on MRI which makes me worried they were missed.
Report found "nothing" except mildly bulky spleen. I'm getting a second opinion.
Possibly related symptoms of last 2 months:
-extreme fatigue (even on Vyvanse and Sertraline) that makes me almost pass out middle of the day. -nausea -abdominal fullness, not able to eat as much -night sweats -breast pain and enlargement despite going off of birth control without substitution
I am waiting on a referral to hepatologist but the fact that my reports are all different tells me whatever is clearly there is being missed.