Frequency of Tumor Entities among Liver Tumors of Unclear Etiology Initially Detected by Sonography in the Noncirrhotic or Cirrhotic Livers of 1349 Patients

Zusammenfassung

Ziel: Untersuchung der Häufigkeit von verschiedenen soliden fokalen Leberläsionen (SFLL) in nicht zirrhotischen und zirrhotischen Lebern unter besonderer Berücksichtigung der Häufigkeit der Metastasierung in Zirrhoselebern.

Material und Methoden: Das Patientenkollektiv der DEGUM-Multicenterstudie (n = 1349) wurde reevaluiert und in ein Subkollektiv A ohne (n = 1067) und B mit Zirrhose (n = 282) unterteilt. Die verschiedenen Tumorentitäten waren zu 74,6 % histologisch gesichert (n = 1006). 

Ergebnisse: Im Subkollektiv A fanden sich 385 Fälle mit Metastasen (36,4 %) und 65 mit HCC (6,1 %), demgegenüber waren an benignen Läsionen Hämangiome mit 237 Fällen (22,4 %) und FNH mit 170 Fällen (16,1 %) am häufigsten. Im Subkollektiv B fanden sich 216 Fälle von HCC (76,6 %) und 12 Metastasen (4,3 %), sowie 42 benigne Läsionen (14,9 %). CCC waren im Subkollektiv A (3,3 %) und im Subkollektiv B (2,5 %) selten. Eine Tumoranamnese erhöht die Wahrscheinlichkeit für eine maligne SFLL im Subkollektiv A 1,8-fach, nicht jedoch im Subkollektiv B.

Schlussfolgerung: Die Häufigkeit der verschieden Tumorentitäten unterscheidet sich bei Patienten mit und ohne Zirrhose grundlegend. In nicht zirrhotischen Lebern sind maligne und benigne SFLL etwa gleich häufig. Im Vordergrund stehen Metastasen, Hämangiome und FNH, CCC sind selten. Eine Tumorvorgeschichte erhöht die Wahrscheinlichkeit auf eine maligne SFLL. Bei Zirrhose dominieren HCC, HCC sind 18-mal häufiger als Metastasen. Benigne SFLL und CCC sind selten

Abstract

Aim: Investigation of the frequency of various solid focal liver lesions (SFLL) in noncirrhotic and cirrhotic livers with focus on the frequency of metastasis in cirrhotic livers.

Material and Methods: The patient collective in the DEGUM multicenter study (n = 1349) was reevaluated and divided in subcollective A without (n = 1067) and B with cirrhosis (n = 282). 74.6 % of the various tumor entities were confirmed histologically (n = 1006).

Results: In subcollective A there were 385 patients with metastases (36.4 %) and 65 with HCC (6.1 %), whereas the most common benign lesions were hemangioma, with 237 cases (22.4 %) and FNH, with 170 cases (16.1 %). In subcollective B there were 216 cases of HCC (76.6 %) and 12 metastases (4.3 %), as well as 42 benign lesions (14.9 %). CCC was rare in both subcollective A (3.3 %) and subcollective B (2.5 %). A positive oncological history increased the probability of a malignant SFLL in subcollective A by 1.8 times, but did not do so in subcollective B.

Conclusion: The frequency of various tumor entities is different in patients with and without cirrhosis of the liver. In noncirrhotic livers, malignant and benign SFLL are equally common. The most common forms are metastases, hemangiomas and FNH, CCC is rare. A positive history of extrahepatic malignancy increases the probability of a malignant SFLL. In cirrhosis, HCC dominates, HCC is 18 times as common as metastases. Benign SFLL and CCC are rare.

Key words

liver tumor - tumor entitiy - metastasis - HCC - liver cirrhosis - ultrasound (US) - CEUS - focal liver lesion, - DEGUM-Multicenter-Trial

• References

• 1 Strobel D, Seitz K, Blank W et al. Contrast-enhanced Ultrasound for the Characterization of focal Liver Lesions – Diagnostic Accuracy in Clinical Practice (DEGUM multicenter trial). Ultraschall in Med 2008; 29: 499-505
• 2 Strobel D, Seitz K, Blank W et al. Tumor-specific Vascularization Pattern of Liver Metastasis, Hepatocellular Carcinoma, Hemangioma and Focal Nodular Hyperplasia in the Differential Diagnosis of 1349 Liverlesions in Contrast-Enhanced (CEUS). Ultraschall in Med 2009; 30: 376-382
• 3 Seitz K, Strobel D, Bernatik T et al. Contrast-enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions – Prospective Comparison in Clinical Practice: CEUS vs. CT (DEGUM Multicenter Trial). Ultraschall in Med 2009; 30: 383-389
• 4 Seitz K, Bernatik T, Strobel D et al. Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions in Clinical Practice (DEGUM Multicenter Trial): CEUS vs. MRIa prospective Comparison in 269 Patients. Ultraschall in Med 2010; 31: 1-8
• 5 Bernatik T, Seitz K, Blank W et al. Unclear Focal Liver Lesions in Contrast-Enhanced Ultrasonography – Lessons to be Learned from the DEGUM Multicenter Study for the Characterization of Liver Tumors. Ultraschall in Med 2010; 31: 577-581
• 6 Mostbeck G. Bildgebende Diagnostik fokaler Leberläsionen: die 90 %-Regel. Ultraschall in Med 2010; 31: 545-547
• 7 Karhunen PJ. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol 1986; 39: 183-188
• 8 Oldenburg A, Albrecht T. Sonografische Leberdiagnostik bei Tumorpatienten ohne und mit Kontrastmittel. Ultraschall in Med 2008; 29: 488-498
• 9 Laghi F, Catalano O, Maresca M et al. Indeterminate, Subcentimetric Focal Liver Lesions in Cancer Patients: Additional Role of Contrast-Enhanced. Ultrasound Ultraschall in Med 2010; 31: 283-288
• 10 Rode A, Bancel B, Douek P et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 2001; 25 (03) 327-336
• 11 Dodd 3rd GD, Baron RL, Oliver 3rd JH et al. Spectrum of imaging findings of the liver in end-stage cirrhosis: Part II, focal abnormalities. Am J Roentgenol 1999; 173 (05) 1185-1192
• 12 Mion F, Grozel L, Boillot O et al. Adult cirrhotic liver explants: precancerous lesions and undetected small hepatocellular carcinomas. Gastroenterology 1996; 111: 1587-1592
• 13 Gaiani S, Gramantieri L, Venturoli N et al. What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy. J Hepatol 1997; 27 (06) 979-85
• 14 Oberti F, Valsesia E, Pilette C et al. Noninvasive diagnosis of hepatic fibrosis or cirrhosis. Gastroenterology 1997; 113 (05) 1609-1616
• 15 Wittstock G, Meyer J, Meyer M. The frequency of hepatocellular carcinoma in autopsy material. Zentralbl Allg Pathol 1988; 134 (02) 189-196
• 16 Petry W, Heintges T, Hensel F et al. Hepatocellular carcinoma in Germany. Epidemiology, etiology, clinical aspects and prognosis in 100 consecutive patients of a university clinic. Z Gastroenterol 1997; 35: 1059-1067
• 17 Kubicka S, Rudolph KL, Hanke M et al. Hepatocellular carcinoma in Germany: a retrospective epidemiological study from a low-endemic area. Liver 2000; 20: 312-318
• 18 Ruiz Guinaldo A, Martín Herrera L, Roldán Cuadra R. Hepatic tumors in patients with cirrhosis: an autopsy study. Rev Esp Enferm Dig 1997; 89: 771-780
• 19 Hamaya K, Hashimoto H, Maeda Y.  Metastatic Carcinoma in Cirrhotic Liver – a Statistical Survey of Autopsies in Japan. Pathology International 1975; 25: 153-159
• 20 Pereira-Lima JE, Lichtenfels E, Babosa FS et al. Prevalence study of metastases in cirrhotic livers. Hepatogastroenterology  2003; 50: 1490-1495
• 21 Melato M, Laurino L, Mucli E et al. Relationship between cirrhosis, liver cancer, and hepatic metastases. An autopsy study. Cancer 1989; 15: 455-459
• 22 Seymour K, Charmley RM.  Evidence that metastasis is less common in cirrhotic than normal liver: a systematic review of post-mortem case-contol studies.  British Journal of surgery 1999; 86: 1237-1242
• 23 Vanbockrijck M, Klöppel G.  Incidence and morphology of liver metastasis from extrahepatic malignancies to cirrhotic livers.  Zentralbl Pathol 1992; 138: 91-96
• 24 MacSween RNM. A clinicopathological review of 100 cases of primary malignant tumours of the liver. J Clin Pathol 1974; 27 (08) 669-682
• 25 Gall EA. Primary and metastatic carcinoma of the liver. Relationship to hepaticcirrhosis. Arch Pathol 1960; 70: 226-232
• 26 Chomet B, Valaitis J, Pearah G. Metastatic carcinoma in the cirrhotic liver. American J of medical Sciences 1959; 238: 753-759
• 27 Hanot V, Gilbert A. Etudes sur les Maladie du Foie. Paris: Asselin&Houzeau; 1888: I3
• 28 Poulain A. Cancer de l'estomac. Noyaux secondaires developpes dans un foie cirhotique. Bul Soc anat de Paris 1898;
• 29 Colwell H. Malignant disease of the liver and bile passages. Arch Middlesex Hosp London 1905; 5: 123-141
• 30 Lisa JR C, Solomon EJ. Gordon:Secondary carcinoma in cirrhosis of the liver. Amer J Pathol 1942; 18: 137-140
• 31 Rolleston RD, McNee JW. Diseases of the Liver,Gall-Bladder and Bile Ducts. 3.. ed. London: Macmillan & Co; 1929
• 32 Wallach JB, Hyman WA, Angrist A. Metastasis to liver in portal cirrhosis. Amer J clin Pathol 1953; 23: 989-993
• 33 Seitz G. Why are metatstases in cirrhotic livers so rare?. Ultraschall in Med 1989; 10: 123-126
• 34 Ruebner BH, Green R, Miayi K et al. The rarity of intrahepatic metastasis in cirrhosis of the liver. Am J Pathol 1961; 179: 537-547
• 35 Fisher ER, Hellstrom HR, Fisher B. Rarity of Hepatic Metastases in Cirrhosis – A Misconception. JAMA 1960; 174: 366-369
• 36 Seitz G. Metastasierungswege. In: Rettenmaier G, Seitz K, (ed.) Sonographische Differentialdiagnostik, Band 2. 1083-1092
• 37 Iascone C, Ruperto M, Barillari P. Occurrence of synchronous colorectal cancer metastasis in the cirrhotic or fatty liver. Minerva Chir 2005; 50: 185-190
• 38 Song E, Chen J, Ou Q et al. Rare occurrence of metastatic colorectal cancers in livers with replicative hepatitis B infection. Am J Surg 2001; 181: 529-533
• 39 Uhlenbruck G, Beuth J, Weidtmann V. Liver lectins: mediators for metastases. Experientia 1983; 39: 1314-1315
• 40 Uetsuji S, Yamamura M, Yamamichi K et al. Absence of colorectal cancer metastasis to the cirrhotic liver. Am J Surg 1992; 164 (02) 176-177
• 41 Gervaz P, Pak-art R, Nivatvongs S et al. Colorectal adenocarcinoma in cirrhotic patients. J Am Coll Surg 2003; 196: 874-879
• 42 Kasper H-U, Drebber U, Dries V et al. Lebermetastasen: Inzidenz und histogenetische Einordnung. Z Gastroenterol 2005; 43: 1149-1157
• 43 Brancatelli G, Federle MP, Blachar A et al. Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 2001; 219 (01) 69-74
• 44 Terada T, Kitani S, Ueda K et al. Adenomatous hyperplasia of the liver resembling focal nodular hyperplasia in patients with chronic liver disease. Virchows Arch A Pathol Anat Histopathol 1993; 422: 247 -252
• 45 Quaglia A, Tibballs J, Grasso A et al. Focal nodular hyperplasia-like areas in cirrhosis. Histopathology 2003; 42: 14 -21
• 46 An HJ, Illei P, Diflo T et al. Scirrhous changes in dysplastic nodules do not indicate high-grade status. J Gastroenterol Hepatol 2003; 18: 660-665
• 47 Nakashima O, Kurogi M, Yamaguchi R et al. Unique hypervascular nodules in alcoholic liver cirrhosis: identical to focal nodular hyperplasia-like nodules?. J Hepatol 2004; 41: 992-998
• 48 Lee YH, Kim SH, Cho MY et al. Focal Nodular Hyperplasia-Like Nodules in Alcoholic Liver Cirrhosis: Radiologic-Pathologic Correlation. AJR 2007; 188
• 49 Libbrecht L, Cassiman D, Verslype C et al.  Clinicopathological Features of Focal Nodular Hyperplasia-Like Nodules in 130 Cirrhotic Explant Livers. The American Journal of Gastroenterology 2006; 101: 2341-2346