mass on dogs liver

Question
QUESTION: My male schnauzer approx. 10 1/2 years old was taken to our vet by my mother-in-law because he wasn't moving around much and was having trouble sitting down.She said he acted like he was in pain.The vet called us(we were traveling) and told us he had hemangiosarcoma on the spleen and would need surgery immediately. Due to the fact that we were gone I told them to sit tight and we would decide what to do when we got home. This vet had us all very upset. I was skeptical because several months ago he had two or three episodes similar and the other vet in this same office told us it was his back. I took him another vet for acupuncture and he bounced back and had not had a problem for quite a while. The mass that was seen on the ultrasound was quite large so we knew it could be serious this time. We met with the surgeon as soon as we got back and insisted he do another ultrasound and look for himself. Sure enough, he said the mass was not on the spleen but on the liver. He did a needle biopsy and the results were negative but he said he still thought it was cancer. We then took our dog to Missouri University in Columbia and they too did ultrasound and said the mass was about the six of a racquet ball. They also did a needle biopsy and said it didn't show malignanacy. They suggested taking it out. They indicated it appeared to be on the outer area of the liver. My question is, if the blood work looks good and two needle biopsys are negative, what are the chances this is cancer? What else could it be? He is doing well, never has vomited and eats good. He does have a pot belly but has had for the last couple of years. I am currently giving a liver tonic dispensed by the vet I use for acupuncture and he also has him on hepatic support from Standard Process.
I am just at a loss on what to do or where to go from here. It is hard to let someone open him up when he seems to be doing so well. Do you often hear about this kind of situation?
So far the doctor that does the acupuncture is the only one that said he doesn't think it is malignant. He has looked at all of the results but suggested it might be best to take this thing off. I really need another opinion.
Thank you for your time.
Sincerely,
Sarah Hush

ANSWER: Sincere apologies for the delayed response.

Aspirates of hemangiosarcoma often will end up as inconclusive, due to the blood filled nature of the tumors.  Often all that will be obtained is relatively normal signs of hemorrhage.  In this way the biopsies serve more to rule out other types of cancer that could be present, than to be able to conclusively show a hemangiosarcoma.

There is the possibility of physical trauma having caused a hematoma (non-cancer, basically a blood filled "bubble"), but given that ultrasound was done I would tend to trust that result over that of the aspirate and worry that hemangiosarcoma is truly present.

Sadly hemangiosarcoma is a very early spreading cancer so there is no guarantee that removal would curative.  However it sounds to me that the size of the mass would lead to discomfort and were it to grow more lead to further problems by nature of the mass effect itself.

If your veterinarian sees him as a decent surgical candidate and it is financially feasible for you this would be giving him the best chance at a longer more comfortable life.  Ultimately the decision is yours weighing the aspects, but whatever you decide I wish you the very best of luck and please feel free to write back if you have further questions.




---------- FOLLOW-UP ----------

QUESTION: How large can a hematoma be? Is there any other non invasive way to tell what type of mass this is. No one has really ever called it a tumor.Do hematomas ever appear on the outer side of the liver? It was indicated to me that this mass was on the outside edge.
He is eating well, playing and acting completely normal. Wouldn't his blood levels be off if it was cancer?
Thanks,
Sarah Hush, mom of Mell
zgraniteman@aol.com

Answer
Hematomas can become rather large and occur on nearly any part of the liver.  The liver is a very vascular organ of the body and rupture of blood vessels is the cause of hematomas, so the potential is high in an organ like the liver.

Finding more specific and definite diagnosis could be difficult given the inability to do so with ultrasound already in his case. Hemangiosarcoma (the cancer of the two) has a high metastasis rate, spreading to other parts of the body quickly.  Your veterinarian could do full body radiographs looking for any such remote tumors which would tend to make hemagiosarcoma a stronger possible diagnosis.  Outside of this there is not a lot to help differentiate outside of what your veterinarians have already attempted.

Blood levels can be askew with cancer but unfortunately they may also be relatively normal so would be an unreliable indicator I am sorry.

Best of luck to you and your canine companion.