Macroscopy

The distribution of metastases from col-orectal carcinoma was found to be homogenous, regardless of the primary site of origin {1695} but in another study, it was suggested that right sided cancers predominantly metastasize to the right lobe of the liver and left sided cancers to both lobes {1749}.

Metastases are nearly always multinodular or diffusely infiltrative, but may rarely be solitary and massive (e.g. from colo-rectal and renal cell carcinomas). Umbilication (a central depression on the surface of a metastatic deposit) is due to necrosis or scarring and is typical of an adenocarcinoma from stomach, pan creas or colorectum. A vascular rim around the periphery is often seen. Highly mucin secreting adenocarcino-mas appear as glistening, gelatinous masses whilst well differentiated kera-tinizing squamous cell carcinomas are granular. Metastatic carcinoid tumours can form pseudocysts {401}. Haemor-rhagic secondary deposits suggest angiosarcoma, choriocarcinoma, carcinoma of thyroid or kidney, neuroendocrine tumour, or vascular leiomyosar-coma. Some diffusely infiltrating carcinomas (e.g. small cell carcinoma), lymphomas and sarcomas may have a soft, opaque 'fish flesh' appearance. Meta-static breast carcinoma in particular can produce an intensely fibrous, granular liver ('carcinomatous cirrhosis') either before {174} or after {1693} treatment. Calcification of secondary deposits is a feature of colorectal carcinoma but it is seldom excessive and has no effect on prognosis {653}. Metastatic melanoma is often, but not always, of a brown-black colour. Secondary tumours may appear in the liver long after the removal of the primary.

Fig. 8.79 Systemic non-Hodgkin lymphoma involving the liver.

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