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(Redirected page to Liver neoplasms#Hepatic 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]]. | |||
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.<ref>OA. 29 November 2009.</ref> | |||
*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.<ref name=pmid8511077>{{Cite journal | last1 = Elias | first1 = D. | last2 = Rougier | first2 = P. | last3 = Mankarios | first3 = H. | last4 = Fahrat | first4 = F. | last5 = Lasser | first5 = P. | title = [Resectable liver metastases and synchronous extra-hepatic sites of colorectal origin. Surgical indications]. | journal = Presse Med | volume = 22 | issue = 11 | pages = 515-20 | month = Mar | year = 1993 | doi = | PMID = 8511077 }} | |||
</ref> | |||
*It is important to consider [[germ cell tumour]]s 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. | |||
<br> | |||
Further reading: | |||
*{{Cite journal | last1 = Anders | first1 = RA. | last2 = Kamel | first2 = IR. | title = Biopsy considerations in the diagnosis of hepatic masses. | journal = Clin Gastroenterol Hepatol | volume = 5 | issue = 5 | pages = 541-4 | month = May | year = 2007 | doi = 10.1016/j.cgh.2007.02.028 | PMID = 17478344 }} | |||
==Gross pathology/radiology== | |||
*Multifocal or solitary. | |||
**Classically multifocal. | |||
<gallery> | |||
Image: Secondary_tumor_deposits_in_the_liver_from_a_primary_cancer_of_the_pancreas.jpg |Hepatic metastases (pancreas). (WC) | |||
</gallery> | |||
==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.<ref name=pmid2440554>{{Cite journal | last1 = Kondo | first1 = Y. | last2 = Nakajima | first2 = T. | title = Pseudoglandular hepatocellular carcinoma. A morphogenetic study. | journal = Cancer | volume = 60 | issue = 5 | pages = 1032-7 | month = Sep | year = 1987 | doi = | PMID = 2440554 }}</ref> | |||
*[[Epithelioid hemangioendothelioma]]. (???) | |||
===Image=== | |||
<gallery> | |||
Image:Adenocarcinoma_liver_metastasis.jpg | Liver metastasis - adenocarcinoma. (WC/Nephron) | |||
</gallery> | |||
==IHC== | |||
*Metastases are typically negative for ''HepPar-1''. | |||
**HepPar-1 (hepatocytes paraffin antibody 1) - labels hepatocellular mitochondria.<ref name=pmid12502967>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.</ref> | |||
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=== | |||
<pre> | |||
LIVER, PORTION OF SEGMENTS 2 AND 3, RESECTION: | |||
- METASTATIC ADENOCARCINOMA. | |||
-- RESECTION MARGIN CLEARANCE 2 MM. | |||
- LIVER STEATOSIS, MILD. | |||
</pre> | |||
===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)<br> | |||
Fibrosis: not identified.<br> | |||
Fibrous septa: absent.<br> | |||
Septa with curved contours: absent.<br> | |||
Large droplet steatosis (% of hepatocytes): mild (20%).<br> | |||
Ballooning of hepatocytes: not identified.<br> | |||
Mallory-Denk bodies: not identified.<br> | |||
Portal inflammation: present, mild.<br> | |||
Interface activity: not identified.<br> | |||
Lobular necroinflammation: not identified.<br> | |||
Ducts: present in normal numbers.<br> | |||
Duct injury: not identified.<br> | |||
Ductular reaction: not identified.<br> | |||
Cholestasis: present peritumoural, otherwise absent.<br> | |||
Terminal hepatic venules: present.<br> | |||
Ground glass cells with routine stains: not identified. | |||
==See also== | |||
*[[Liver neoplasms]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Liver neoplasms]] |
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