Liver & intrahepatic bile ducts

Other malignancies

Metastases



Last author update: 1 August 2012
Last staff update: 27 January 2023 (update in progress)

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PubMed Search: Metastases to liver[TI]


Shilpa Jain, M.D.
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Cite this page: Jain S. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livertumormet.html. Accessed January 28th, 2023.
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
  • Metastatic carcinomatous cirrhosis: metastatic carcinoma to liver, often from breast, that incites an extensive fibrotic reaction simulating cirrhosis
  • Breast carcinoma metastatic to liver:
    • 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+
  • Colon carcinoma metastatic to liver: resection of metastases may improve long term survival
  • Hepatoid adenocarcinoma metastatic to liver: may arise in lung or stomach
Case reports
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
  • Colon carcinoma metastatic to liver: large umbilicated nodules with extensive necrosis and fibrosis, variable calcification
  • Squamous cell carcinoma metastatic to liver: soft nodules due to necrosis and keratinization
Gross images

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Multiple metastases

Colonic adenocarcinoma metastases

Microscopic (histologic) description
  • Sinusoidal dilation, cholestasis, portal lymphocytic infiltrate or tumor
  • Colon carcinoma metastatic to liver: tubular, papillary or cribriform patterns of columnar cells with basophilic cytoplasm and elongated nuclei, extensive necrosis
  • Gastrointestinal stromal tumor (GIST) metastatic to liver: polygonal, spindle to epithelioid cells
  • Melanoma metastatic to liver: may replace hepatic cords and grow in trabecular pattern with endothelial lining
  • Pancreaticobiliary metastases to liver: atypical angulated glands with desmoplasia
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D. and Semir Vranic, M.D., Ph.D.

Ocular melanoma metastatic to liver: 70 year old woman with liver mass

Melanoma metastatic to liver: uveal melanoma



Contributed by @liverwei on Twitter
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Metastases



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Metastatic breast carcinoma to liver

Gastric hepatoid adenocarcinoma metastatic to liver

Positive stains
Negative stains
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