Lebermetastasen: Inzidenz und histogenetische Einordnung

Abstract

Metastases are the most common malignant tumors of the liver. In the files of the Institute of Pathology of the University of Cologne 12,161 liver tissue cases are registered. Of them, 1,357 cases (11.2%) showed tumors or tumor like masses. Liver metastases of solid tumors were the largest group of the neoplasias with 611 cases (5.0%) followed by hepatocellular carcinoma (380 cases; 3.1%). Other entities were rare and include cholangiolar carcinoma (0.5%), vascular tumors (0.4%), lymphomas (0.4%), focal nodular hyperplasias (0.36%) and liver cell adenomas (0.23%). Adenocarcinomaa are the largest group of metastases with 400 cases (65.5%). 48.2% of this group were metastases of colorectal cancer, 13.5% of pancreatic cancer, 13% of breast cancer, 6.2% of gastric cancer, 4.5% of lung cancer and 3.7% of esophageal cancer. Neuroendocrine carcinomas are the second largest group with 16% of liver filiae. Other entities were rarely found. Metastases in cirrhotic livers are seldom. The gross findings, the histology, the differential diagnosis including immunohistochemistry and the value of the liver biopsy is discussed.

Primary and Metastatic Tumours of the Liver: Expanding Scope of Morphological and Immunohistochemical Details in the Biopsy

“…Lymphoma constituted 0.4% of all tumours [2]. Metastases in cirrhotic liver were rare [2]. In another study, including 130 cases of metastatic liver disease, gastrointestinal tract was found to be the most common primary location (45.3%) of cancer metastasizing to liver followed by neuroendocrine tumours (10.7%) [104].…”

“…Neuroendocrine carcinomas were seen frequently (16%). Lymphoma constituted 0.4% of all tumours [2]. Metastases in cirrhotic liver were rare [2].…”

“…In metastases, organospecific markers including CDX2, mammaglobin, nuclear expression of TTF-1 or presence of neuroendocrine markers can confirm extra-hepatic origin [17]. As colorectal, breast, lung and neuroendocrine cancers are frequent cause of metastatic liver damage [2] high diagnostic value of immunohistochemistry (IHC) can be expected. However, the exact detection of histogenesis can be difficult with metastatic pancreatic or gastric tumours and highgrade malignancies.…”

Immunohistochemical Markers Distinguishing Cholangiocellular Carcinoma (CCC) from Pancreatic Ductal Adenocarcinoma (PDAC) Discovered by Proteomic Analysis of Microdissected Cells

“…In metastatic PDAC tissue ANXA1 and ANXA10 showed similar staining behavior as in the primary PDAC tumors ( The majority of malignant neoplasms located in the liver are metastases originating from primary tumor sites in other organs, most commonly the colon or the pancreas (1). In many cases, a histological or immunohistological examination by an experienced pathologist can specify the type and origin of the underlying cancer.…”

“…Hepatocellular carcinoma or hepatic metastasis from primaries such as pulmonary adenocarcinoma, colorectal adenocarcinoma, and breast carcinoma are usually easily distinguishable by morphology and means of known immunohistochemical markers. For primary cholangiocellular carcinoma (CCC) 1 and metastases of pancreatic ductal adenocarcinoma (PDAC), however, the distinction in a liver biopsy is basically an unsolvable task because of their high similarity. This is an important and frequently asked clinical question though, because treatment options differ significantly for the two cancer types.…”