<human>: Dear Dr, My niece who is 35 yrs old has the following medical report. Sonography report hepatic mass: echogenic mass lesion at the right lobe 1.3cm and also 10cmx6.4cm mass Gall bladder and cbd: mild thick wall 0.44cm and there are small bright reflective shadow seen Tumor remark report:  all negative CEA 1.38ng/ml, CA 19-9 9.4u/ml, AFP 2.14ng/ml, CA125 25.6u/ml Lumbosacral spine mri report:  L2 vertebra abnormal T1 and T2 prolongation show heterogeneous enhancement on post contrast scan. Hemoglobin 7.9gm% but 10.9 after she took 2nits blood, ESR 104mm/hr, SGOT 47u/l and hepatitis is normal HIV positive  with CD4 103 and lose above 10kg Dear Dr, my niece is hospitalized but seriously sick . What is the best treatment  for her? we are from Africa , Ethiopia Thank you
<bot>: Hello, I can understand your concern for your nieces' health.1) USG says, there is small mass in region of gallbladder and bile duct which might extend into liver and also there is thickening of bile duct.2) MRI data says there is small lesion in lower vertebra.3) Blood tests for tumor markers are slightly elevated.4) All these three suggest possibility of malignancy of common bile duct (cholangiocarcinoma).5) For confirmation she might require a) MRI abdomen with MRCP and b) Traffic CT abdomen c) PET-CT scan to check for spread of tumor if it is confirmed.6) Confirmation of malignancy would require endoscopic USG guided FNAC from lesion.7) If it is confirmed that tumor in bile duct has spread in vertebra then only chemotherapy will help. In absence of spread to vertebra, surgery will give best result.8) As she also has HIV infection, her immunocompromised and poor general condition will also affect treatment decision-making. Hope I answered your query. If you have any further doubts then I would be happy to help you. Have a nice day!