Liver & intrahepatic bile ducts
Other malignancies
Metastases
Author: Shilpa Jain, M.D.
Last author update: 1 August 2012
Last staff update: 27 January 2023 (update in progress)
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Metastases to liver[TI]
Table of Contents
Definition / general | Case reports | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stainsCite 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
- 38 year old woman with infiltrating ductal carcinoma of breast with associated florid fibrosis (Arch Pathol Lab Med 2001;125:1084)
- 60 year old woman with female adnexal tumor of probable Wolffian origin metastatic to liver (Arch Pathol Lab Med 2000;124:431)
- 62 year old man with rectal polyp with bone and liver metastases (Am J Surg Pathol 1999;23:838)
- 76 year old man with primary tumor in large intestine (Arch Pathol Lab Med 2001;125:1251)
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
Images hosted on other servers:
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
Metastases
Metastases
Images hosted on other servers:
Metastatic breast carcinoma to liver
Gastric hepatoid adenocarcinoma metastatic to liver
Positive stains
Negative stains
- Gastrointestinal stromal tumor (GIST) metastatic to liver: HepPar1, glypican 3
- Hepatoid adenocarcinoma metastatic to liver: CK7, HepPar1, glypican 3
