Zusammenfassung
Metastasen sind die häufigsten bösartigen Tumoren der Leber. Im Leberregister des Institutes für Pathologie der Universität zu Köln sind seit 1996 von insgesamt 12 161 Leberproben in 1357 Fällen (11,2 %) Tumoren oder tumorähnliche Neubildungen nachgewiesen worden. Die größte Gruppe innerhalb der Neubildungen machen mit 611 Fällen (5 %) Lebermetastasen solider Tumoren aus. An 2. Stelle finden sich hepatozelluläre Karzinome (380 Fälle). Die anderen Tumoren sind seltener und schließen cholangioläre Karzinome (0,5 %), Gefäßtumoren (0,4 %), Lymphome (0,63 %), fokale noduläre Hyperplasien (0,36 %) und Leberzelladenome (0,23 %) ein. Adenokarzinome waren die häufigsten sekundären Lebertumoren mit insgesamt 400 Fällen (65,5 %), wobei 48,2 % Metastasen von Kolonkarzinomen, 13,5 % von Pankreaskarzinomen, 13 % von Mammakarzinomen, 6,2 % von Magenkarzinomen, 4,5 % von Bronchialkarzinomen und 3,7 % von Ösophaguskarzinomen waren. Mit 16 % stellen neuroendokrine Karzinome die zweithäufigste Gruppe von Lebermetastasen dar. Andere Tumorgruppen waren wesentlich seltener. Sekundäre Lebertumoren siedeln sich sehr selten in einer Leber mit Zirrhose ab. Der makroskopische Aspekt, die Histologie und die Differenzialdiagnose unter Berücksichtigung der Immunhistochemie und die Bedeutung der Leberbiopsie werden diskutiert.
Abstract
Metastases are the most common malignant tumors of the liver. In the files of the Institute of Pathology of the University of Cologne 12,161 liver tissue cases are registered. Of them, 1,357 cases (11.2 %) showed tumors or tumor like masses. Liver metastases of solid tumors were the largest group of the neoplasias with 611 cases (5.0 %) followed by hepatocellular carcinoma (380 cases; 3.1 %). Other entities were rare and include cholangiolar carcinoma (0.5 %), vascular tumors (0.4 %), lymphomas (0.4 %), focal nodular hyperplasias (0.36 %) and liver cell adenomas (0.23 %). Adenocarcinomaa are the largest group of metastases with 400 cases (65.5 %). 48.2 % of this group were metastases of colorectal cancer, 13.5 % of pancreatic cancer, 13 % of breast cancer, 6.2 % of gastric cancer, 4.5 % of lung cancer and 3.7 % of esophageal cancer. Neuroendocrine carcinomas are the second largest group with 16 % of liver filiae. Other entities were rarely found. Metastases in cirrhotic livers are seldom. The gross findings, the histology, the differential diagnosis including immunohistochemistry and the value of the liver biopsy is discussed.
Schlüsselwörter
Lebermetastasen - Prävalenz - Histologie - Pathologie - Primärtumor
Key words
Liver metastases - prevalence - histology - pathology - primary tumor
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Dr. H.-U. Kasper
Institut für Pathologie, Universität zu Köln
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