A 28-year-old Japanese man had been clear for 21 months after surgery for testicular cancer when a routine surveillance scan turned up something new. A 20-millimeter low-density lesion, oddly dumbbell-shaped, had appeared in segment 7 of his liver. Three earlier scans had shown nothing.
His team at Mie University Hospital in Tsu ran everything they had. Tumor markers were normal. Ultrasound identified an irregular mass with indistinct margins and no blood flow signal. MRI showed the pattern you would expect from a tumor. A PET scan showed no abnormal glucose uptake, which was reassuring but not conclusive. Because he had a history of cancer, they could not exclude metastasis, so they removed part of the liver laparoscopically.
