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Metastatic Liver Disease: Secondary Alterations of Hepatic Metastases

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Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

Abstract

Hepatic metastases undergo several types of secondary changes. Part of these alterations is mainly observed in tumor progression, when neoplasms increase in size and are subject to decreasing vascular supply and oxygenation. Large and rapidly growing hepatic metastases typically show necrosis. This necrosis is commonly of the coagulation type and is, in the absence of chemotherapy, caused by tumor hypoxia. Hypoxic necrosis mainly involves central parts of a metastatic nodule, while blood circulation in peripheral parts is preserved. Usual necrosis can also be induced by chemotherapy, which in addition can elicit infarct-like necrosis. Necrotic tumor tissue often undergoes dystrophic calcification. Rupture of tumor blood vessels in necrotic areas may result in massive hemorrhage, and involvement of adjacent bile ducts induces bile impregnation of necrotic areas. Large necrosis may undergo sequestration, can burst, or become infected by circulating or ascending bacteria. Infection of necrotic tissue may result in large collections of pus and, in case of infection with gas-producing microorganisms, show pneumatic lesions. In necrotic metastases, anaerobic bacteria can elicit hepatic necrobacillosis. A rare secondary alteration of metastases is spontaneous regression, known for several types of tumors.

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    Arthur Zimmermann

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Zimmermann, A. (2017). Metastatic Liver Disease: Secondary Alterations of Hepatic Metastases. In: Tumors and Tumor-Like Lesions of the Hepatobiliary Tract. Springer, Cham. https://doi.org/10.1007/978-3-319-26956-6_109

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