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| ==Hepatic metastasis== | | ==Hepatic metastasis== |
| {{Main|Metastasis}} | | {{Main|Liver metastasis}} |
| *[[AKA]] ''liver metastases''. | | *[[AKA]] ''liver metastases''. |
| *[[AKA]] ''metastatic liver disease''. | | *[[AKA]] ''metastatic liver disease''. |
| ===General===
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| *Metastases are very common - often from the gastrointestinal tract, e.g. [[colorectal cancer]].
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| **Most liver masses in are not biopsied... as a primary lesion is evident.<ref>OA. 29 November 2009.</ref>
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| *Dependent on the extent of disease, [[CRC]] metastatic to the liver may be curable with a liver resection.
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| **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 }}
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| </ref>
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| *It is important to consider [[germ cell tumour]]s in the DDx as these may be curable with chemotherapy.
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| *Clear cell variant of HCC may be misdiagnosed as metastatic [[clear cell carcinoma]].
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| *Interhepatic cholangiocarcinoma is an adenocarcinoma - it may look like a metastatic lesion.
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| <br>
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| Further reading:
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| *{{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 }}
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| ===Gross pathology/radiology===
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| *Multifocal or solitary.
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| **Classically multifocal.
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|
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| <gallery>
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| Image: Secondary_tumor_deposits_in_the_liver_from_a_primary_cancer_of_the_pancreas.jpg |Hepatic metastases (pancreas). (WC)
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| </gallery>
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|
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| ===Microscopic===
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| Features:
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| *Histologic features are dependent on primary and degree of differentiation.
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| The classic liver metastasis ([[colorectal carcinoma]]):
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| *Gland forming columnar shaped cells with pseudostratified hyperchromatic cigar-shaped nuclei.
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|
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| DDx:
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| *[[Cholangiocarcinoma]].
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| *[[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>
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| *[[Epithelioid hemangioendothelioma]]. (???)
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| ====Image====
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| <gallery>
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| Image:Adenocarcinoma_liver_metastasis.jpg | Liver metastasis - adenocarcinoma. (WC/Nephron)
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| </gallery>
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|
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| ===IHC===
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| *Metastases are typically negative for ''HepPar-1''.
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| **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>
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|
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| Note:
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| *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.
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| ===Sign out===
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| <pre>
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| LIVER, PORTION OF SEGMENTS 2 AND 3, RESECTION:
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| - METASTATIC ADENOCARCINOMA.
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| -- RESECTION MARGIN CLEARANCE 2 MM.
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| - LIVER STEATOSIS, MILD.
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| </pre>
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|
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| ====Micro====
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| The section show liver parenchyma with an invasive adenocarcinoma. The adenocarcinoma
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| has well formed glands with dirty necrosis. The nuclei are appear crowded and
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| have an ellipsoid shape. Focally, zones of necrosis are present. See background liver.
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|
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| BACKGROUND LIVER (BASED ON H&E ONLY)<br>
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| Fibrosis: not identified.<br>
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| Fibrous septa: absent.<br>
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| Septa with curved contours: absent.<br>
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| Large droplet steatosis (% of hepatocytes): mild (20%).<br>
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| Ballooning of hepatocytes: not identified.<br>
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| Mallory-Denk bodies: not identified.<br>
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| Portal inflammation: present, mild.<br>
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| Interface activity: not identified.<br>
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| Lobular necroinflammation: not identified.<br>
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| Ducts: present in normal numbers.<br>
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| Duct injury: not identified.<br>
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| Ductular reaction: not identified.<br>
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| Cholestasis: present peritumoural, otherwise absent.<br>
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| Terminal hepatic venules: present.<br>
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| Ground glass cells with routine stains: not identified.
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| =See also= | | =See also= |