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Answer to your Health Question

Question:

In July 2010 I was diagnosed with Biliary Hamartomas through US, CT scan, and MRI.

The conclusions of the MRI were:

MRI imaging with liver specific contrast dynamic scanning confirmed the presence of multiple subcentimetre predominantly cystic lesions with no significant enhancement and benign characteristics compatible with hamartoma of von Mellenburgs syndrome.

The focal lesion in segment 8 conforms to simple fat suggestive of a benign hepatic lipoma.

The further lesion in segment 6 of the liver was not evident on MR imaging and most likely represented phasic enhancement of this segment during CT scanning.

It was confirmed that there was no need for biopsy at this stage and at most the patient requires medium to long term follow up by CT scan to confirm their size stability ( 6 to 12 months).

Now I have been having permanent pain in upper right side which causes a lot of discomfort.

I also feel pain in the lower left side of the abdomen.

From time to time I feel nausea.

Could that be something much serious than just the Biliary Hamartomas which should not have any symptoms?

Please help me as I would need to seek treatment outside of my own country.

Thanking you in advance.

Best regards, Ana

Answer:

Dear Ana,

Biliary hamartomas are benign malformations of the bile ducts.

The significance of these biliary hamartomas lies in the possibility of these lesions being mistaken for more serious lesions, such as, metastatic carcinoma.

Histologic studies can clarify the benign nature of the tumor and establish the correct diagnosis.

Biliary hamartomas are also known as biliary microhamartomas or von Meyenburg complex and they are benign liver malformations consisting of focal disorderly collections of bile ducts, surrounded by abundant fibrous stroma.

Biliary hamartomas may cause single or multiple nonspecific hepatic lesions that may mimic metastases.

The lesions found in patients with biliary hamartomasusually are less than 1 cm in diameter and are relatively uniform in size, as opposed to the lesions in patients with metastatic diseases, which typically are not uniform in size.

Biliary hamartomas may cause dull pain in the might upper quadrant that radiate to the flank.

Their presence of bile duct hamartoma can cause diagnostics confusion and complicate the patient's management.

Although biliary hamartomas do not because symptoms right upper quadrant pain and abdominal pain due to biliary hamartomas may be possible.

Although imaging studies are useful for giving a differential diagnosis the final diagnosis should be proved by histopathology.

Biliary hamartomas are a rare cause of multiple benign hepatic lesions.

The literature has documented its possible progression to malignant neoplasia. However, this relationship has only been established with cholangiocarcinomas.

Heinke T, Pellacani LB, Costa Hde O, Fuziy RA, and Franco M. in 2008 reported for the first time on the association of the lesion of biliary hamartomas with hepatocellular carcinoma.

Jaundice and right upper quadrant pain due to bile duct hamartomas were findings reported by Joan Rodés in 2007.

We suggest that liver biopsy should be done in hepatic lesions with uncertain clinical features, because the histological findings may change the treatment plan.

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