INTRODUCTION The liver is one of the organs mostly involved in metastatic disease from a variety of cancers, in particular those of the 4,56,7gastrointestinal tract, lung and breast Metastatic tumors . are most commonly found in liver during autopsy. 40% of 1,10patients who died of cancer have hepatic metastases . In general patients with hepatic metastases die within 1 year. In the last instance, 5 years survival rate of 25% to 39% have 11been reported after resection of hepatic metastases . In a large series of 10,736 malignant neoplasm, PICKREN et al 1982 reported that the metastatic tumour in the liver was 41 1,10times more common than the primary hepatic tumour . Sometimes, liver metastases can occur even when the primary cancer is removed. Common symptoms of metastatic liver cancer are abdominal pain, loss of appetite, weight loss, nausea, jaundice and unexplained fever. Liver cancer symptoms often do not appear in the early stages. As a result, liver cancer tends to be diagnosed at a more advanced stage. So, identication of risk factors and early diagnosis are the key issues for effective interventions. Information on liver metastases is very limited from this part of the country. Keeping all these views in mind, the present study was conducted with the following objectives 1. To study liver metastases in adults in relation to primary malignancy, clinical presentations, age and sex. 2. To correlate gross morphological appearances with histopathological features. 3. To study liver metastases in adults in relation to liver function test (LFT) and cause of Death with complications. MATERIAL AND METHODS: The present study was based on autopsy material. This was a descriptive cross sectional retrospective and prospective study carried out for the period of four years at tertiary care hospital. All the adult autopsies during this 4 years period were screened for liver metastases. Details of clinical history, examination and results of various investigative procedures with particular reference to liver function tests were obtained from hospital records whenever available. Standard routine procedure was used for xation, embedding and sectioning. All sections were stained with Hematoxylin and Eosin. OBSERVATION AND RESULTS: In present study we came across 16 cases of metastasis (80% of cases as compared to 20% of primary malignant tumors). Metastatic involvement of liver is far more common than 1primary neoplasia . The commonest clinical presentation were abdominal distention (62.50%), ascites (62.50%), abdominal pain (56.25%), jaundice (56.25%), hepatomegaly 4,5(50%), weight loss (43.75%) Primary site of the metastasis . were lung (25%), gastrointestinal malignancy (18.75%), breast (12.5%), gall bladder (6.25%), pancreas (6.25%), urinary bladder (6.25%) and leukemia (25%), which coincide 2,7,8with reports in literature . In present study middle aged predominately male adults were more commonly affected followed by elderly adults. The study 4,5,6,7with Male Female ratio of 3:1 . In all cases grossly liver was enlarged with more than one nodule distributed randomly in liver with central necrosis in 5nodules (Fig. 1, 2, 3) and histologically all metastasis was similar to respective of primary malignancy. (Fig. 4, 5, 6). Histology pleomorphic inltrate affecting the portal tract and 2,3,9 parenchyma was seen in leukemia (Fig. 7) In present study . the commonest cause of death was disseminated malignancy. Fig 1: Metastasis of breast (IDC), showing multiple metastatic nodules Fig 2: Metastasis of intestine (GIST) showing multiple metastatic nodules. AUTOPSY STUDY OF LIVER METASTASES IN ADULT PATIENTS IN TERTIARY CARE HOSPITAL OF MUMBAI. Original Research Paper Dr. Ujwal K. Rathod Associate Professor, Dept of Pathology, Hinduhridaysamrat Balasaheb Thackeray Medical College, Juhu, Mumbai-400056. X 117GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Medical Science Silent liver diseases are common amongst apparently healthy individuals and are sometimes diagnosed only at autopsy. In present study we came across 16 cases of liver metastasis. Metastasis present in 80% of cases as compared to 20% of primary malignant tumors. It is observed that in adults metastasis in liver from other primary 1,2 sites is much more common than primary hepatic tumors which is also similarly reported in literature The commonest clinical presentation were abdominal distention (62.50%), Ascites (62.50%), abdominal pain (56.25%), jaundice (56.25%), 1,2,4,5hepatomegaly (50%), weight loss (43.75%) . Clinical features quite inconsistent, patient can be often be asymptomatic. Obstructive jaundice, massive intraperitoneal haemorrhages and features mimicking cirrhosis are other unusual 1,3,12manifestations . In liver metastasis, middle age, predominantly male adults were more commonly affected. The liver is 1common site for metastases mainly from breast, lung and colon, stomach and pancreas . However cancer at any site of body 1may spread to the liver . ABSTRACT KEYWORDS : Liver Metastases. Autopsy. Millind Patil Associate Prof., Dept of Pathology, LTMMC &GH, Sion, Mumbai-400022. Dr. Smita Santosh Chavhan* Associate Professor, Dept of Community Medicine, Hinduhridaysamrat Balasaheb Thackeray Medical College, Juhu, Mumbai-400056. *Corresponding Author VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 118 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Fig 3: Intestine (GIST). Histological all metastasis was similar to respective primary malignancy (Fig. 4, 5, 6). Fig 4: Metastasis of breast (IDC) (H & E 100x) Fig 5: Metastasis of intestine (GIST) (H & E 100x) Fig 6: Metastasis of pancreas (Adenocarcinoma) (H& E 100x) Fig 7: AML – Leukemic inltrate in portal tract and sinusoids (H & E 100 x) TABLE 1: SITES OF MALIGNANCIS IN MATASTATIC TUMOUR Lung and gastrointestinal malignancies were the common site of primary malignancies. TABLE 2: AGE AND SEX DISTRIBUTION OF METASTATIC CASES: In present study middle aged predominately male adults were more commonly affected followed by elderly adults. Male: Female ratio is 3:1. DISCUSSION: As seen from present study, Liver metastatic cancer is not an uncommon disease in this part of India. In present study we came across 16 cases of metastasis. Metastasis present in 80% of cases as compared to 20% of primary malignant tumors. It is observed that in adults metastasis in liver from other primary sites is much more common than primary as 2reported in literature . The commonest clinical presentation were abdominal distention (62.50%), Ascites (62.50%), abdominal pain (56.25%) jaundice (56.25%) hepatomegaly 4,5(50%), weight loss (43.75%) . Primary site of the metastasis were lung (25%), gastrointestinal malignancy (18.75%), breast (12.5%), gall bladder (6.25%), pancreas (6.25%), urinary bladder 6.25% and leukemia (25%) which coincide 1with reports in literature . Grossly, most metastatic carcinoma form multiple, spherical, nodular masses which are variable size with hepatomegaly. The tumour deposits are grey white, well demarcated, soft to rm, with areas of hemorrhages in few cases. The surface of the liver shows characteristic central umbilication. Histologically all metastasis was similar to 1,5respective of primary malignancy . In present study middle aged (41-60 yrs) adults were more commonly affected. Male predominates in present study with Male: Female ratio of 3:1. CONCLUSION: It may be concluded from the present study that metastatic involvement of liver is far more common than primary 2neoplasia . Metastasis present in 80% of cases as compared to 20% of primary malignant tumors. Metastatic tumors are most commonly found in liver during autopsy and if not 1,2detected early may lead to serious outcome . The liver is common site for metastases mainly from breast, lung and 1colon, stomach, gall bladder and pancreas . Any cancer 1inside of the body may spread to the liver including leukemia . The study was conducted on the specimen collected from the mortuary and not reect the actual pattern of liver diseases and emphasizes the need for further studies for early detection and treatment of the vulnerable group of people in the local population. Autopsy study is a good stepping stone towards achieving good morphological accuracy. In secondary liver cancer, continue to be an important cause of morbidity and mortality in tropical countries. Early diagnosis and prompt interventions improve the survival and outcome of the disease. REFERENCES: 1. Ishak KG, Goodman ZD, Stocker JT. Tomours of the Liver and Intrahepatic Bile Ducts. In Rosai J Sobin LH, eds.Atlas of tumor pathology Washington, DC: Armed Forces Institite of Pathology,2001. 2. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation of within portal hepatic. AM J. 1965; 38: 247-256. 3. Shehab TM Kaminski MS. Lok AS. Acute liver failure to hepatic involvement hematological malignancy. Dig Dis Sci 1997; 42: 1400-1405. 4. Pikren JW,Tsukada T,Lane WW.Liver Metastases.Analysis of Autopsy data.In Weiss L, Gilber HA (eds): Liver Metastases . Boston, 1982,G.K.Hall 5. Schulz W. Hort W.The distribution of metastases in the liver . A quantitative postmortem study.Virchos Arch (A)1981,394:89-96. 6. Lefkkowitch.JH.The epidemiology and morphology pf primary malignant liver tumors. Surg Chin North Am 1981;61:169-180. 7. Iazobuzio –Donahue C , Ferrell LD Secondary tumours of the liver .In of the Digestive System .Lyon.France:IARC Press, 2010;251-253. 8. Disibio G. French SW . Metasases patterns of cancers;result from a large autopsy study . ARCH Pathol Lab Med 2008:132:931-939. 9. Roquest ML , Zafrani ES , Farcet JP , et al. Histopathological lesion of the liver in hairy cells leukemia : a report of 14 cases. Hepatology 1985; 5:496-500. 10. Tumors of Liver and extrahepatic bile ducts. In Hamilton S.R., Aaltonen LA,eds. World health Oeganisation classicartion of tumors: pathology and genetics of tumor of the digestive system.Lyon France:IARC press,2000. 11. Fong Y. Blumgart LH, Cohen AM. Surgical treatment of colorectal metastases to the liver, CA Cancer J. Clin 1995; 45:50-62. 12. Borja ER, Hari JM. Pugh RP.Metastatic Ca of liver mimicking cirrhosis cancer 1975;35:445-449. VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Sr. No. Site of Primary malignancy No. of cases % 1. Lung 4 25 2. Lymph reticular system (leukemia) 4 25 3. Gastrointestinal malignancies 3 18.75 4. Breast 2 12.50 5. Urinary bladder 1 6.25 6. Gall Bladder 1 6.25 7. Pancreas 1 6.25 Age group Sex: Male Female 18-40 yrs (Young adults) 5 1 41-60 yrs (Middle age) 6 2 60 yrs (Elderly) 1 1 Total 12 4