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Liver and intrahepatic bile ducts - tumor

Other malignancies

Metastases to liver


Reviewers: Shilpa Jain, M.D. (see Reviewers page)
Revised: 19 April 2014, last major update August 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

General
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● In US, only 2% of hepatic malignancies in non-cirrhotic liver are hepatic primaries (i.e. 98% are metastases) vs. 77% are hepatic primaries in cirrhotic liver
● Direct extension is common from tumors of extrahepatic bile ducts, gallbladder, pancreas and stomach
● Metastases in adults often from breast, colon, lung, pancreas; in children from neuroblastoma, rhabdomyosarcoma, Wilm's tumor
● Unknown primary is often determined to be from lung, pancreas, stomach
● Metastatic nodules tend to outgrow their blood supply and produce central necrosis and umbilication
● Symptoms often of abdominal pain, ascites and jaundice; portal hypertension less common
● Survival usually less than 1 year, longer if primary is neuroendocrine carcinoma or neuroblastoma; also some cases of colon carcinoma with resection of hepatic metastases
● Should compare metastatic tumor to prior malignancies

Case reports
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● 60 year old woman with female adnexal tumor of probable wolffian origin metastatic to liver (Arch Pathol Lab Med 2000;124:431)

Gross description
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● 90% are multiple, variable size, may replace entire liver and locally elevate the capsule or not be visible on external surface
● Often hemorrhage and necrosis; extensive hemorrhage suggests choriocarcinoma, angiosarcoma or thyroid carcinoma
● Cannot determine malignancy based on gross appearance only

Gross images
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Multiple metastases

Micro description
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● Sinusoidal dilation, cholestasis, portal lymphocytic infiltrate or tumor


Metastatic carcinomatous cirrhosis

General
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● Metastatic carcinoma to liver, often from breast, that incites an extensive fibrotic reaction simulating cirrhosis

Case reports
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● 38 year old woman with infiltrating ductal carcinoma of breast with associated florid fibrosis (Arch Pathol Lab Med 2001;125:1084)

Xray images
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Marked hepatic contour irregularity is consistent with macronodular cirrhosis


Metastatic carcinoma

Gross images
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Macronodular cirrhosis


Breast carcinoma metastatic to liver

General
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● Post-treatment metastases produce coarsely lobulated appearance known as hepar lobatum, associated with syphilis
● Estrogen receptor 35% sensitive and highly specific; progesterone receptor neither sensitive nor specific (Arch Pathol Lab Med 2003;127:1591)
● Mammoglobin+ and GCDFP-15+

Micro images
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Metastatic breast carcinoma to liver


Colon carcinoma metastatic to liver

General
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● Resection of metastases may improve long term survival

Case reports
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● 62 year old man with rectal polyp with bone and liver metastases (Am J Surg Pathol 1999;23:838)

Gross description
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● Large umbilicated nodules with extensive necrosis and fibrosis, variable calcification

Gross images
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Colonic adenocarcinoma metastases

Micro description
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● Tubular, papillary or cribriform patterns of columnar cells with basophilic cytoplasm and elongated nuclei, extensive necrosis


Gatrointestinal stromal tumor (GIST) metastatic to liver

Micro description
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● Polygonal, spindle to epithelioid cells

Positive stains
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● CD117, vimentin

Negative stains
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● HepPar1, Glypican 3


Hepatoid adenocarcinoma metastatic to liver

General
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● May arise in lung or stomach

Micro images
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Gastric hepatoid adenocarcinoma metastatic to liver

Positive stains
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● AFP, CK8, CK19 and CK20 (Am J Surg Pathol 2003;27:1302)

Negative stains
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● CK7, HepPar1, Glypican-3


Melanoma metastatic to liver

Micro description
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● May replace hepatic cords and grow in trabecular pattern with endothelial lining

Micro images
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Uveal melanoma, contributed by Dr. Semir Vranic, Clinical Center of the University of Sarajevo (Bosnia)


Pancreaticobiliary metastases to liver

Micro description
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● Atypical angulated glands with desmoplasia


Squamous cell carcinoma metastatic to liver

Case reports
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● 76 year old man with primary tumor in large intestine (Arch Pathol Lab Med 2001;125:1251)

Gross description
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● Soft nodules due to necrosis and keratinization

Micro images
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FNA, H&E and synaptophysin

End of Liver and intrahepatic bile ducts - tumor > Other malignancies > Metastases to liver


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