Liver and intrahepatic bile ducts - tumor
Other malignancies
Metastases to liver

Author: Shilpa Jain, M.D. (see Authors page)

Revised: 5 December 2017, last major update August 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Metastases to liver[TI]

Cite this page: Jain, S. Metastases to liver. PathologyOutlines.com website. http://pathologyoutlines.com/topic/livertumormet.html. Accessed December 13th, 2017.
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
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
Gross images

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Multiple metastases

Microscopic (histologic) description
  • Sinusoidal dilation, cholestasis, portal lymphocytic infiltrate or tumor
Metastatic carcinomatous cirrhosis
Definition / general
  • Metastatic carcinoma to liver, often from breast, that incites an extensive fibrotic reaction simulating cirrhosis


Radiology images

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Marked hepatic
contour irregularity
is consistent with
macronodular cirrhosis

Metastatic carcinoma



Case reports

Gross images

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Macronodular cirrhosis

Breast carcinoma metastatic to liver
Definition / general
  • 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

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Metastatic breast carcinoma to liver

Colon carcinoma metastatic to liver
Definition / general
  • Resection of metastases may improve long term survival


Case reports

Gross description
  • Large umbilicated nodules with extensive necrosis and fibrosis, variable calcification


Gross images

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Colonic adenocarcinoma metastases



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
  • Polygonal, spindle to epithelioid cells


Positive stains

Negative stains
Hepatoid adenocarcinoma metastatic to liver
Definition / general
  • May arise in lung or stomach


Microscopic (histologic) images

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Gastric hepatoid adenocarcinoma metastatic to liver



Positive stains

Negative stains
Melanoma metastatic to liver
Microscopic (histologic) description
  • May replace hepatic cords and grow in trabecular pattern with endothelial lining


Microscopic (histologic) images

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Images contributed by Dr. Semir Vranić, Clinical Center of the University of Sarajevo (Bosnia):

Uveal melanoma

Ocular melanoma metastatic to liver
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Dr. Raul Gonzalez, University of Rochester Medical Center, New York (USA):

70 year old woman with liver mass

Pancreaticobiliary metastases to liver
Microscopic (histologic) description
  • Atypical angulated glands with desmoplasia
Squamous cell carcinoma metastatic to liver
Case reports

Gross description
  • Soft nodules due to necrosis and keratinization


Microscopic (histologic) images

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FNA, H&E and synaptophysin