Pathology of liver tumours

The liver is an important site for primary and secondary tumours. In western countries, the commonest malignant neoplasm of the liver is metastatic carcinoma, but hepatocellular carcinoma is a common and important cause of death elsewhere. There is a strong association with infection by hepatitis-B and -C; the latter explains the growing incidence of hepatocellular carcinoma in western countries. It is a complication of cirrhosis of any cause; male sex is an important risk factor. Such associations do not exist for the rare variant fibrolamellar carcinoma, which carries a better prognosis than the common form (where survival is measured in weeks). Cholangiocarcinoma, a malignant tumour of bile ducts, accounts for about 15% of primary intrahepatic malignancies; recent epidemiological studies have shown dramatic increases in its incidence. There is a strong association with primary sclerosing cholangitis and, in the Far East, with hepatolithiasis and infection by liver flukes. Epithelioid haemangioendothelioma and angiosarcoma are the commonest malignant mesenchymal tumours in the liver. A number of benign tumours and tumour-like lesions may mimic malignant neoplasms.