Difference between revisions of "Liver neoplasms"

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Liver neoplasms (view source)

Revision as of 17:01, 5 September 2014

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→‎Hepatic metastasis
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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===
*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=
=See also=
Michael
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