Abstract
In 5 years, 64 solid hepatic lesions have been referred for diagnosis and management which have been found unexpectedly on organ imaging in well patients. We have called this lesion a “dystychoma”. Patients have undergone a two phase investigation programme which allows a diagnosis without admission to hospital in about 50% of cases. About three quarters of patients (47/64) have had nonneoplastic lesions, and about half (33/64) have had haemangiomas. About one patient in four (17/64) has had a neoplasm, and the neoplasm has been malignant in about one in six (11/64) of all patients. We stress the need to pursue the diagnosis in these patients. There were no reliable clinical, biochemical or imaging characteristics which individually distinguished benign from malignant lesions. Age over 55 years, an enlarged liver or a palpable liver mass and a raised serum alkaline phosphatase were all significantly more frequent with malignant tumours. The risk of malignancy rose with the number of risk factors, and all patients with all three risk factors had malignant tumours. Only 11 of the 64 patients were judged to have benefited by significant increase in quality or quantity of life as a result of what was frequently inappropriate organ imaging. There is no strong argument for replacing history taking and physical examination by CT scanning, ultrasound examination or other organ imaging.
Highlights
In 1990, members of this Unit drew attention to a new clinical entity a solid lesion found unexpectedly by organ imaging in the liver of a relatively well patient[1]. We originally named this a hepatic "incidentaloma", but have felt that the finding has not been truly incidental in some patients who have had symptoms compatible with liver pathology
A dystychoma is defined as an unexpected solid lesion in the liver of a patient with a Karnofsky index of 80% or more, detected or confirmed by organ imaging using computerised tomography (CT) or ultrasound[1]
The clinical problem presented by the chance finding of a solid lump in the liver on organ imaging was described by this unit in 1990 under the name "hepatic incidentaloma’’1, but we recognise that the term "incidentaloma" is misleading
Summary
In 1990, members of this Unit drew attention to a new clinical entity a solid lesion found unexpectedly by organ imaging in the liver of a relatively well patient[1]. We originally named this a hepatic "incidentaloma", but have felt that the finding has not been truly incidental in some patients who have had symptoms compatible with liver pathology. We have been advised by a skilled medical etymologist that the term "dystychoma" meaning "unlucky tumour" might be more appropriate. We here report on an extended experience with this entity over 5 years, and make further suggestions about the epidemiology, diagnosis and management of the lesion
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