Difference between revisions of "Liver metastasis"
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A '''liver metastasis''' is a malignant [[metastatic]] neoplasm in the liver that arose elsewhere. Liver metastases are more common than primary [[liver neoplasms]]. | A '''liver metastasis''' is a malignant [[metastatic]] neoplasm in the liver that arose elsewhere. Liver metastases are more common than primary [[liver neoplasms]]. | ||
It is also known as '''metastatic liver disease''' and ''hepatic metastasis'''. | It is also known as '''metastatic liver disease''' and '''hepatic metastasis'''. | ||
Metastatic disease in general is dealt with in the ''[[metastasis]]'' article. | Metastatic disease in general is dealt with in the ''[[metastasis]]'' article. | ||
Revision as of 17:00, 5 September 2014
A liver metastasis is a malignant metastatic neoplasm in the liver that arose elsewhere. Liver metastases are more common than primary liver neoplasms.
It is also known as metastatic liver disease and hepatic metastasis.
Metastatic disease in general is dealt with in the metastasis article.
General
- Metastases are very common - often from the gastrointestinal tract, e.g. colorectal cancer.
- Most liver masses in are not biopsied... as a primary lesion is evident.[1]
- Dependent on the extent of disease, CRC metastatic to the liver may be curable with a liver resection.
- Peritoneal disease, i.e. a malignant peritoneal nodule, in the context of liver metastases does poorly, and is considered a contraindication to liver resection.[2]
- It is important to consider germ cell tumours in the DDx as these may be curable with chemotherapy.
- Clear cell variant of HCC may be misdiagnosed as metastatic clear cell carcinoma.
- Interhepatic cholangiocarcinoma is an adenocarcinoma - it may look like a metastatic lesion.
Further reading:
- Anders, RA.; Kamel, IR. (May 2007). "Biopsy considerations in the diagnosis of hepatic masses.". Clin Gastroenterol Hepatol 5 (5): 541-4. doi:10.1016/j.cgh.2007.02.028. PMID 17478344.
Gross pathology/radiology
- Multifocal or solitary.
- Classically multifocal.
Hepatic metastases (pancreas). (WC)
Microscopic
Features:
- Histologic features are dependent on primary and degree of differentiation.
The classic liver metastasis (colorectal carcinoma):
- Gland forming columnar shaped cells with pseudostratified hyperchromatic cigar-shaped nuclei.
DDx:
- Cholangiocarcinoma.
- Hepatocellular carcinoma, pseudoglandular.[3]
- Epithelioid hemangioendothelioma. (???)
Image
Liver metastasis - adenocarcinoma. (WC/Nephron)
IHC
- Metastases are typically negative for HepPar-1.
- HepPar-1 (hepatocytes paraffin antibody 1) - labels hepatocellular mitochondria.[4]
Note:
- If a primary is already established by pathology and the clinical impression is a metastasis, it isn't necessary to do IHC if the morphology of the lesion in the liver is compatible with the established primary.
Sign out
LIVER, PORTION OF SEGMENTS 2 AND 3, RESECTION: - METASTATIC ADENOCARCINOMA. -- RESECTION MARGIN CLEARANCE 2 MM. - LIVER STEATOSIS, MILD.
Micro
The section show liver parenchyma with an invasive adenocarcinoma. The adenocarcinoma has well formed glands with dirty necrosis. The nuclei are appear crowded and have an ellipsoid shape. Focally, zones of necrosis are present. See background liver.
BACKGROUND LIVER (BASED ON H&E ONLY)
Fibrosis: not identified.
Fibrous septa: absent.
Septa with curved contours: absent.
Large droplet steatosis (% of hepatocytes): mild (20%).
Ballooning of hepatocytes: not identified.
Mallory-Denk bodies: not identified.
Portal inflammation: present, mild.
Interface activity: not identified.
Lobular necroinflammation: not identified.
Ducts: present in normal numbers.
Duct injury: not identified.
Ductular reaction: not identified.
Cholestasis: present peritumoural, otherwise absent.
Terminal hepatic venules: present.
Ground glass cells with routine stains: not identified.
See also
References
- ↑ OA. 29 November 2009.
- ↑ Elias, D.; Rougier, P.; Mankarios, H.; Fahrat, F.; Lasser, P. (Mar 1993). "[Resectable liver metastases and synchronous extra-hepatic sites of colorectal origin. Surgical indications].". Presse Med 22 (11): 515-20. PMID 8511077.
- ↑ Kondo, Y.; Nakajima, T. (Sep 1987). "Pseudoglandular hepatocellular carcinoma. A morphogenetic study.". Cancer 60 (5): 1032-7. PMID 2440554.
- ↑ The diagnostic value of hepatocyte paraffin antibody 1 in differentiating hepatocellular neoplasms from nonhepatic tumors: a review. Lamps LW, Folpe AL. Adv Anat Pathol. 2003 Jan;10(1):39-43. Review. PMID 12502967.