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AdenoCA of Colon : Liver Metastases

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Metastases from Colorectal Cancer: The most common sites of involvement are regional lymph nodes and liver (shown here) followed by peritoneum, lung, and ovaries. Liver metastases are an indicator of poor prognosis. Resection of isolated liver metastases can help improve survival if at least 1 cm clear margin is obtained.

Uncommon sites include brain, urinary bladder, bone, testis, uterus, and oral cavity. Given the frequency of ovarian metastases, prophylactic bilateral oophorectomy is recommended in post-menopausal women at the time of colectomy. Metastatic deposits may mimic primary tumor at the respective sites. For e.g. in ovaries they may be mistaken for primary endometrioid adenocarcinoma or clear cell carcinoma of the ovary. Metastases to urinary bladder may ulcerate to involve the urothelial surface and mimic primary adenocarcinoma of the bladder.

Metastases categories in TNM Staging: M0 - No detectable metastasis anywhere in the body. It is a global designation not assigned by the pathologist as it is based on imaging and other modalities. M1: Metastasis to one or more distant sites/organs or peritoneal metastasis. M1a: metastasis to one site/organ; no peritoneal metastasis. Multiple metastases within only one organ, even if the organ is paired (e.g. lungs, ovaries), is still M1a. M1b: Metastasis to multiple distant sites/organs; no peritoneal metastasis. M1c: Metastasis to peritoneal surface (peritoneal carcinomatosis) with or without other organ/site metastases is designated M1c. It occurs in 1-4% of patients. M1c is associated with worse prognosis than that with M1a and M1b.

This autopsy specimen shows metastatic colorectal adenocarcinoma in the liver. Multiple pink-tan necrotic tumor nodules can be seen in the background of a cirrhotic liver.

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