A 69-year-old woman arrives in the emergency room complaining of weakness, abdominal pain, and a 9 kg (20 lb) weight loss during the past month. Physical examination reveals jaundice, conspicuous hepatomegaly, and ascites. The patient expires, and a section of the liver is examined at autopsy as shown in the image. Which of the following is the most likely diagnosis?
Hemangiosarcoma of the liver
Metastatic carcinoma of the liver
Primary hepatocellular carcinoma
- Liver metastasis is the most common cause of massive hepatomegaly and the most common tumor of the liver.
- The liver is involved in one third of all metastatic cancers, including half of those of the gastrointestinal tract, breast, and lungs.
- Other tumors that characteristically metastasize to the liver are pancreatic carcinoma and malignant melanoma, although any cancer may find its way to the liver.
- Although hemangiosarcomas of the liver are frequently multifocal, the tumors are hemorrhagic. Primary hepatocellular carcinoma is incorrect because it usually shows a solitary, poorly circumscribed mass, generally in the background of cirrhosis.
- Miliary tuberculosis and sarcoidosis feature mm-sized inflammatory nodules (minute granulomas).