DEAR DR. ROACH: I was diagnosed with several liver cysts over 15 years ago. My primary doctor and I followed the growth of the cysts by ultrasound, and one is increasing in size. We did an MRI with and without contrast to take a look at the cyst. The radiologist stated that the cyst looked “complex” and, for a lack of a better word, unusual.
A liver specialist’s consult revealed that we could remove it if I wanted to. The doctor stated that he just had a patient who had a cyst, and it was cancerous. He felt that it may be best to remove it, but it’s not urgent to do so.
I would appreciate your take on this situation. — L.S.
ANSWER: Simple liver cysts are common, and even when they are large, they do not need to be removed unless they cause symptoms.
However, any other cyst than a simple one needs to be carefully evaluated.
There are many possible causes, including various types of cancer, especially a mucinous cystic neoplasm, which can be associated with invasive cancer.
I looked at both the ultrasound and MRI reports you sent, and although it seemed to me that the radiologists thought this was likely a simple cyst with some bleeding, they could not be sure. Furthermore, the growth in the size of the cyst is concerning.
In some cases, it’s reasonable to wait and redo the scans in 6-12 months when the risk of a cancerous cyst is low.
However, since the liver specialist (who has much more experience than I do) is concerned enough to recommend surgery, I don’t understand why you would want to wait. I suspect the surgery will prove that it was a benign cyst, but you’ll probably sleep better at night once you know for certain.
The surgery is normally done laparascopically, and although it’s usually a very safe and effective surgery, there is always a small risk for complications. You should speak with a surgeon.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible.
Readers may email questions to ToYourGoodHealth@med.cornell. edu.