24168              MULTIFOCAL HEPATOMA

The patient was a man aged 58 who presented with 3 months history of anorexia, nausea, vomiting, loss of weight and pain in the right upper quadrant. The liver was large, hard and tender; there was palmar erythema, Dupuytren's contracture and feminine distribution of pubic hair. He had been a heavy drinker for 8 years. There were raised serum levels of LDH and AAT and the prothrombin was 50%. Liver scan showed enlargement and patchy uptake and biopsy showed well differentiated adenocarcinoma resembling bile ducts. He was discharged, but after 3 weeks developed increasing ascites and oedema of the legs which did not respond to treatment. At postmortem there was massive ascites and there were small metastatic deposits in both lungs. The liver weighed 5670 gms.

The specimen is a slice of the liver which shows multiple confluent foci of tumour throughout the substance of the organ. Many of the nodules show opaque yellow necrosis. Histology shows a slightly anaplastic and rather scirrhous carcinoma forming small irregular ducts like bile ducts, composed of clear cuboidal cells. There are many areas of necrosis. Invasion of veins is prominent.