Tumours of the Liver

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The liver may be involved by secondary tumours.
The most common malignant tumour of the liver is metastatic tumour. Spread to the liver is via the bloodstream, either from the portal vein in the case of tumours in the gastrointestinal tract, or by the systemic circulation for other tumours.

Clinically the liver is enlarged, feeling hard and craggy on palpation.
The lung, breast, colon, and stomach are the most common primary sites of tumours metastasizing
to the liver. Many other tumours also spread to the liver, but they are numerically less frequent.
There is often involvement by tumours of the lympho-reticular system, malignant lymphomas,
and by malignant tumours of the bone marrow,leukaemias.

Small deposits of tumour in the liver have little clinical effect but, when extensive, metastases
cause compression of the intra-hepatic bile ducts and lead to obstructive jaundice.

The liver contains multiple nodules of white metastatic tumour. In this instance the primary
lesion was in the breast.

Benign tumours of the liver may be derived from several cell types
Primary hepatocellular carcinoma is predisposed by cirrhosis, hepatitis B infection and mycotoxins
Primary carcinomas derived from hepatocytes are termed hepatocellular carcinomas, often referred
to as hepatomas.

The predisposing factors for development are cirrhosis (independent of cause), hepatitis B
infection with chronic carrier status, and mycotoxins contaminating food. For example, Aspergillus flavus
produces a powerful toxin that readily causes hepatocellular carcinoma and is a frequent contaminant
of stored nuts and grains in tropical countries.
The marked geographic variation seen in the incidence of this condition (very high in Africa
and the Far East) is probably due to environmental levels of mycotoxins and high hepatitis B carrier rates.

Serum a-fetoprotein levels may be raised in cases of hepato-cellular carcinoma and are demonstrable
by immunochemistry in tumour cells.

The prognosis is very poor, with a median survival of under 6 months from diagnosis.
Cholangiocarcinoma is predisposed by chronic inflammatory diseases of bile ducts
Adenocarcinomas arising from the intrahepatic bile duct epithelium are termed cholangiocarcinomas.
They may be predisposed by chronic inflammatory diseases of the intrahepatic biliary tree, particularly
sclerosing cholangitis and disease caused by liver flukes.
Macroscopically lesions may be single or multifocal and are associated with a very poor prognosis, most patients being dead within 6 months of diagnosis.

Angiosarcomas of the liver are caused by exposure to environmental agents
Derived from vascular endothelium, angiosarcomas are highly malignant tumours that appear
as multifocal haemorrhagic nodules within the liver.
Importantly, such tumours are rare unless there has been exposure to thorotrast (a radiological
contrast agent used until the 1950s), vinyl chloride monomer (used in the plastic industry to make PVC),
arsenic (administered in the past in certain 'tonics'), or anabolic steroids.

Tumour appears as an abnormal mass within the liver. Histologically (b) tumour
is composed of liver cells with atypical nuclear cytology and abnormal architectural arrangement.
Bile secretion by tumour cells may be seen.
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