Histopathologic Features of Primary Hepatocellular Carcinomas Are Poor Predictors of Extrahepatic Metastasis
Erica F Clayton, Lea F Surrey, Melissa A Grilliot, Matthew H Levine, Emma E Furth. Hospital of the University of Pennsylvania, Philadelphia, PA
Background: Extrahepatic metastases of hepatocellular carcinoma (HCC) are uncommon, and studies characterizing this subset of HCCs are lacking. This study aims to 1) compare the histopathologic features of primary and metastatic HCCs and 2) determine whether any histologic features of primary HCC are predictive of extrahepatic metastasis.
Design: In this retrospective study, patients with tissue diagnoses of both primary and metastatic HCC between 1996 –2012 were identified from our institution's pathology archives. A blinded re-review was performed on the original diagnostic slides. Tumor architecture, histologic grade, and mitotic rate were evaluated. Primary tumors were additionally assessed for lymphovascular invasion.
Results: Twenty-five metastatic HCCs and their corresponding primary tumors were identified from 21 patients (81% male, 19% female, mean age at primary diagnosis 57.6 years, range 44-74 years). Primary tumors were from 17 explanted livers and 4 partial hepatectomies. Time between resection of primary and metastatic tumors ranged from 3 to 69 months (average = 21.6 months). Lymphovascular invasion was identified in 17 of 21 (81%) primary HCCs. Metastatic sites and histologic features are shown below.
|Metastatic site||n (%)|
|- Left||4 (16)|
|- Right||4 (16)|
|- Unspecified (endobronchial)||1 (4)|
|Abdominal wall||3 (12)|
|Ostomy site||2 (8)|
|Vertebral meninges||1 (4)|
|Small bowel||1 (4)|
|Unspecified soft tissue||1 (4)|