Table of Contents
Definition / general | Case reports | Gross description | Gross images | Microscopic (histologic) description | Metastatic carcinomatous cirrhosis | Breast carcinoma metastatic to liver | Colon carcinoma metastatic to liver | Gastrointestinal stromal tumor (GIST) metastatic to liver | Hepatoid adenocarcinoma metastatic to liver | Melanoma metastatic to liver | Ocular melanoma metastatic to liver | Pancreaticobiliary metastases to liver | Squamous cell carcinoma metastatic to liverCite this page: Jain S. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livertumormet.html. Accessed January 22nd, 2021.
Definition / general
- In U.S., only 2% of hepatic malignancies in noncirrhotic 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, Wilms 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
- 60 year old woman with female adnexal tumor of probable Wolffian origin metastatic to liver (Arch Pathol Lab Med 2000;124:431)
Gross description
- 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
Microscopic (histologic) description
- Sinusoidal dilation, cholestasis, portal lymphocytic infiltrate or tumor
Metastatic carcinomatous cirrhosis
Definition / general
Case reports
- Metastatic carcinoma to liver, often from breast, that incites an extensive fibrotic reaction simulating cirrhosis
Case reports
- 38 year old woman with infiltrating ductal carcinoma of breast with associated florid fibrosis (Arch Pathol Lab Med 2001;125:1084)
Breast carcinoma metastatic to liver
Definition / general
Microscopic (histologic) images
Images hosted on other servers:
- Posttreatment 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 GCDFP15+
Microscopic (histologic) images
Images hosted on other servers:
Colon carcinoma metastatic to liver
Definition / general
Case reports
Gross description
Gross images
Images hosted on other servers:
Microscopic (histologic) description
- Resection of metastases may improve long term survival
Case reports
- 62 year old man with rectal polyp with bone and liver metastases (Am J Surg Pathol 1999;23:838)
Gross description
- Large umbilicated nodules with extensive necrosis and fibrosis, variable calcification
Gross images
Images hosted on other servers:
Microscopic (histologic) description
- Tubular, papillary or cribriform patterns of columnar cells with basophilic cytoplasm and elongated nuclei, extensive necrosis
Gastrointestinal stromal tumor (GIST) metastatic to liver
Microscopic (histologic) description
Positive stains
Negative stains
- Polygonal, spindle to epithelioid cells
Positive stains
Negative stains
Hepatoid adenocarcinoma metastatic to liver
Definition / general
Microscopic (histologic) images
Images hosted on other servers:
Positive stains
Negative stains
- May arise in lung or stomach
Microscopic (histologic) images
Images hosted on other servers:
Positive stains
- AFP, CK8, CK19 and CK20 (Am J Surg Pathol 2003;27:1302)
Negative stains
Melanoma metastatic to liver
Ocular melanoma metastatic to liver
Pancreaticobiliary metastases to liver
Microscopic (histologic) description
- Atypical angulated glands with desmoplasia
Squamous cell carcinoma metastatic to liver
Case reports
Gross description
- 76 year old man with primary tumor in large intestine (Arch Pathol Lab Med 2001;125:1251)
Gross description
- Soft nodules due to necrosis and keratinization