Liver metastasis occurs secondary to the spread of melanomas, renal cell carcinoma, neuroendocrine tumors and the primary cancers involving various sites of the body. Of these, the commonest is the colon, followed by non-colorectal locations such as breast, lungs, pancreas, etc. [1]. 95% of uveal melanomas metastasize to the liver versus 15% of cutaneous melanomas [2] [3] [4] [5] and liver metastasis has been reported in approximately 44% of neuroendocrine tumors [6] [7] [8].

In a majority of the patients, the metastases are multiple with concomitant spread to other sites [9] [10] while a small percentage of patients develop solitary lesions. 75% of the patients have involvement of bilateral lobes of the liver. The incidence and pattern of the metastases depend on the age, sex, primary site of the tumor, duration, and histopathology. Primary liver cancer is less common as compared to liver metastasis.

In the initial stages of the disease, patients with liver metastasis are asymptomatic. Subsequently, they develop non-specific symptoms like anorexia, weight loss, fever, night sweats, cachexia and right upper quadrant pain. On palpation, hard, tender hepatomegaly may be noted. Jaundice is rare in the early stages and is typically seen in the presence of bile duct obstruction. Ascites develops with peritoneal seeding of the tumor and in advanced stages, there is hyperbilirubinemia with hepatic encephalopathy.

• Weight Loss

  Liver metastases are suspected in patients with weight loss and hepatomegaly or with primary tumors likely to spread to the liver. [msdmanuals.com]

  Patients with a primary cancer are suspected of having liver metastasis if they present with weight loss and a palpable, enlarged and hard liver. [symptoma.com]

• Falling

  We report a unique case of a metastatic lesion to the liver consisting of a urothelial carcinoma with hepatoid features, a tumor that likely falls within the hepatoid adenocarcinoma spectrum. [ncbi.nlm.nih.gov]

  The IgG- CIC level correlated well with the percent fall of FEV, during the TDI brochoprovocation test(r=0.69, p=0.005), but poorly correlated with methacholine PC20. [kiss.kstudy.com]

  Often, but not always, cancer cells fall into this category of being hypermetabolic. In addition, not everything that is hypermetabolic is cancer. The results of these and other tests may not provide definitive information. [my.clevelandclinic.org]

  I would say that roughly 70% of her hair remains and has quit falling out. Also, she doesn't suffer from neuropathy anymore and she doesn't suffer from really bad fatigue. [cancercompass.com]

• Feeding Difficulties

  When the condition begins early in life, babies have difficulty gaining weight ( failure to thrive ), feeding difficulties, and a pale appearance. Babies may also have weak muscle tone ( hypotonia ) and seizures. [rarediseases.info.nih.gov]

  Patients with cblD present with severe learning difficulties, behavioral problems and movement and gait abnormalities and patients with cblF and cblJ present with feeding difficulties, hypotonia, stomatitis, mild facial dysmorphism, cardiac malformations [orpha.net]

• Weight Gain

  Corticosteroids can cause sleep problems, increased appetite, fluid buildup in the legs, arms or face, weight gain, high blood sugar levels, infection, mood changes and skin problems (such as a rash or acne). NSAIDs can upset the stomach. [cancer.ca]

• Short Stature

  These can include: learning disabilities or intellectual disabilities delays in walking and motor skills abnormal involuntary movements ( dystonia and chorea ) rigid muscle tone, called spasticity poor growth with short stature skin rashes and infections [newbornscreening.info]

• Pneumonia

  The most common cause of lobar pneumonia is Streptococcus pneumoniae. [radiopaedia.org]

  Image Lobular Pneumonia Sample Lobular Pneumonia 40x Lobular Pneumonia 400x Keuhko Some macrophages can be seen in the alveoli. Congestion can be seen in the alveolisepta (arrowhead) and fibrous fibrin-network in the alveoli is also seen (arrows). [solunetti.fi]

• Nausea

  Nausea and vomiting If you feel sick (nausea) or are vomiting, it’s likely to be due to your cancer, its treatment or emotional side effects such as anxiety. [breastcancercare.org.uk]

  Medications can help with specific symptoms such as pain, nausea and itchiness. It’s more difficult to treat loss of energy and appetite, which are common in advanced stages of illness. [virtualhospice.ca]

  Symptoms The symptoms of liver metastases include: Poor appetite Loss of weight Colour of the urine becomes dark Swelling in the abdomen Jaundice Pain in the right portion of the abdomen Feeling of nausea and vomiting Confusion Fever Liver becomes enlarged [medanta.org]

  If a tumor has metastasized to the brain, symptoms may include headache, dizziness, visual problems, speech problems, nausea, difficulty walking or confusion. Bone metastasis may or may not cause pain. [my.clevelandclinic.org]

• Abdominal Pain

  A 50-year-old woman complained of abdominal pain beneath the xiphoid process for 1 day. Physical checkup revealed tenderness at the right upper abdomen. A fecal occult blood test was positive. [ncbi.nlm.nih.gov]

• Diarrhea

  A 72-year-old man was referred to our hospital complaining of abdominal discomfort, diarrhea, and weakness over the last month. Colorectal liver metastases concurrent intrahepatic cholangiocarcinoma (ICC). [ncbi.nlm.nih.gov]

  However, in our patient when paclitaxel 100 mg weekly had been used with pegylated adriamycin as a third line chemotherapy, patient develop severe grade IV diarrhea and his performance status deteriorated very fast from which he could not recover. [npplweb.com]

  My feeling is that the chemo can be very harmful, but theoretically less harmful than the cancer, so the diarrhea shouldn't be a surprise. [cancercompass.com]

  Side effects, which can be severe, include fatigue and diarrhea. Hormonal therapy Hormonal therapy can slow or stop the growth of certain types of tumors that rely on hormones to grow, such as breast and prostate cancer. [healthline.com]

• Failure to Thrive

  Affiliated tissues include brain, and related phenotypes are failure to thrive and nausea and vomiting [malacards.org]

  Symptomatic patients present with asymmetric chest wall expansion, respiratory distress, dyspnea, tachycardia, cyanosis, and failure to thrive. [orpha.net]

  When the condition begins early in life, babies have difficulty gaining weight ( failure to thrive ), feeding difficulties, and a pale appearance. Babies may also have weak muscle tone ( hypotonia ) and seizures. [rarediseases.info.nih.gov]

  Neonatal presentation of this condition includes failure to thrive, encephalopathy, psychomotor retardation, haematological abnormalities of the three series and renal damage 1. [revistanefrologia.com]

• Hypertension

  […] rhabdomyosarcoma, Wilms tumor Unknown primary is often determined to be from lung, pancreas, stomach Metastatic nodules tend to outgrow their blood supply and produce central necrosis and umbilication Symptoms often of abdominal pain, ascites and jaundice; portal hypertension [pathologyoutlines.com]

  Hypertension, grade 2 hand-foot syndrome and hypothyreosis also developed in relation to the successful sunitinib treatment. These side effects are predictive biomarkers in patients responding well to sunitinib. [ncbi.nlm.nih.gov]

  If the tumour were to invade the portal vein, this can cause portal hypertension, which in turn shunts pressure into the systemic venous system. This can cause oesophageal varices which are prone to spontaneous and catastrophic bleeding. [biology.stackexchange.com]

  Patients with ascites, cirrhosis, or portal hypertension were excluded. [onclive.com]

  Possible uveal melanoma in the left eye was diagnosed in a 74-year-oldwhite woman with a history of hypertension. The melanoma was discovered aftershe sought evaluation for decreased visual acuity in that eye. [jamanetwork.com]

• Liver Mass

  Liver and gastric masses were detected by abdominal computed tomography, and the preoperative relationship between liver and gastric masses was unknown. [ncbi.nlm.nih.gov]

  Metastasis of squamous carcinoma to liver Metastasis of Squamous carcinoma to liver. A. Dark blue tumor groups mass to replace liver.B. [librepathology.org]

  […] detection of focal liver masses and the differentiation of benign from malignant lesions Hemangiomas are reliably diagnosed with MRI General US findings US appearance of liver metastases is nonspecific Hepatomegaly The liver surface may appear nodular [learningradiology.com]

  Arterial-phase contrast- enhanced CT scan shows a cystic lesion with high attenuation of the surrounding normal liver parenchyma (arrows) due to hyperemia (the double target sign). 27.  focal fatty infiltration of the liver does not display mass effect [slideshare.net]

• Osteoporosis

  […] can include: learning disabilities or intellectual disabilities delays in walking and motor skills abnormal involuntary movements ( dystonia and chorea ) rigid muscle tone, called spasticity poor growth with short stature skin rashes and infections osteoporosis [newbornscreening.info]

• Flushing

  These hormones could cause characteristic patterns of symptoms, like flushing, diarrhea, and palpitation. NETs are comparatively uncommon, with an incidence range from 2.5 to 5.3 per 100,000 ( 1 ). [atm.amegroups.com]

  The bypass circuit is composed of a venous Delcath 16F polyethylene catheter with one large fenestrated lumen and 3 accessory lumens, flushed bypass tubing, 2 filters, and the internal jugular central venous return line. [hrjournal.net]

• Alopecia

  […] liver NET metastasis. 11,12 De Baere et al published a preliminary report of 20 patients that showed 80% objective tumor response and disease control, with a TTP of 15 months. 11 Interestingly, and as expected, drug toxicity was very low with grade 2 alopecia [interventionaloncology360.com]

  Skin involvement is seen in about 5% of patients with colorectal cancer [1] where it appears as subcutaneous or intradermal small nodules, and it can be confused with cysts, lipomas, neurofibromas, or alopecia due to these characteristics [2, 3]. [hindawi.com]

• Aggressive Behavior

  Although the overwhelming majority of renal EAMLs are benign, cases of aggressive behavior and malignancy have been reported. [ncbi.nlm.nih.gov]

  This pattern suggests aggressive behavior and is seen in bronchogenic, breast and colon carcinoma,. [radiologyassistant.nl]

• Personality Change

  Less common features of the condition include eye problems and a blood disorder called megaloblastic anemia. [1] When the disorder begins in adolescence or adulthood, the signs and symptoms usually include behavior and personality changes and cognitive [rarediseases.info.nih.gov]

  Breast cancer cells that have spread to the brain cause persistent, progressively worsening headache, visual changes, seizures, nausea, vomiting, vertigo, behavioral and personality changes and increased intracranial pressure. [breast-cancer.ca]

• Irritability

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

  […] over time. 13,16 Some authors suggested that the incidence of DEB-TACE-related bile duct injury is likely the result of inadvertent retention at the capillary peribiliary network of DEB loaded with doxorubicin causing blood flow stasis and chemical irritation [interventionaloncology360.com]

Patients with a primary cancer are suspected of having liver metastasis if they present with weight loss and a palpable, enlarged and hard liver. Routine laboratory tests like a complete blood count and liver function tests may be inconclusive in the early stages although alkaline phosphatase, gamma-glutamyl transpeptidase, and lactate dehydrogenase levels may be elevated.

Plain X-ray chest is performed as a routine in patients with a known primary cancer to exclude pulmonary lesions.

Radiological tests such as ultrasonography, computed tomogram (CT) and magnetic resonance imaging (MRI) are required to detect the metastasis. CT with contrast is the study of choice to diagnose the disease with MRI being more sensitive as compared to CT and positron emission tomography (PET) [11]. However, Kinkel et al, have reported that fluorodeoxyglucose (FDG) PET scan is the most sensitive imaging modality to detect liver metastases, especially if the primary tumor is located in the colon, and upper gastrointestinal tract [12]. Liver angiography is indicated in vascular metastasis, especially if, embolization is being considered as a therapeutic modality.

Histopathological evaluation of a liver biopsy specimen obtained under image guidance is usually required for confirmation of the diagnosis.

• Hypoglycemia

  It has many important well known functions in cell proliferation, biosynthesis of nicotinamide monoand dinucleotide and hypoglycemia [1]. [clinicsinsurgery.com]

Stereotactic body radiation therapy (SBRT) is reported as a well-tolerated treatment modality, which offers a long-term tumor control. [ncbi.nlm.nih.gov]

Therefore, D-dimer may help predict recurrence and prognosis in patients with CRLM. [ncbi.nlm.nih.gov]

The epidemiology, etiology, clinical diagnosis and treatment of the disease remain challenging, because case reports of the disease are few in number. [ncbi.nlm.nih.gov]

Etiology About 50% of cases have no identifiable etiology; however an abnormality or absence of cartilaginous rings, intrinsic obstruction caused by redundant mucosa, extrinsic obstruction (vascular or bronchial) or hyperinflation alone might explain [orpha.net]

대한천식알레르기학회(구 대한알레르기학회) ㆍ수록지정보 : 천식 및 알레르기 / 16권 / 4호 ㆍ저자명 : 이지호, 박영민, 김태윤, 김형옥, 김정원 영어 초록 Familial cold urticaria is a rare abnormal cutaneous and systemic reaction to cold with autosomal dominant inheritance, distinctive clinical features, and unknown etiology [happycampus.com]

다운로드 (기관인증 필요) 초록보기 Familial cold urticaria is a rare abnormal cutaneous and systemic reaction to cold with autosomal dominant inheritance, distinctive clinical features, and unknown etiology. [kiss.kstudy.com]

The epidemiology, etiology, clinical diagnosis and treatment of the disease remain challenging, because case reports of the disease are few in number. [ncbi.nlm.nih.gov]

Colorectal Cancer Epidemiology: Incidence, Mortality, Survival, and Risk Factors. Clin Colon Rectal Surg. 2009 November; 22(4): 191–197. [bead.btg-im.com]

Summary Epidemiology It is a rare disease with the birth prevalence being 1/20,000 to 1/30,000. Clinical description Most cases present in the neonatal period or in early infancy. [orpha.net]

However, the involvement of mesenchymal stem cells (or their derivatives) in tumour pathophysiology has not been addressed. [ncbi.nlm.nih.gov]

Brain metastases: epidemiology and pathophysiology. [neurosurgery.theclinics.com]

Some considers these two as pathophysiologically the same, differing only in target organs. Bronchial hyperreactivity of asthma patients has been well documented, but whether they also have nasal hyperreactivity is unknown. [kiss.kstudy.com]

The pathophysiology of RILD is not well understood. Pathologically, venoocclusive disease, similar to that seen following bone marrow translation, is seen. [aboutcancer.com]

Considering that skin metastases developed close to the primary cancer in a setting of heavy nodal disease, the likely pathophysiology is a combination of intravascular and lymphatic dissemination. [thepermanentejournal.org]

Tailoring microwave ablation device protocols to tumor type might prevent incomplete ablations. [ncbi.nlm.nih.gov]

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