METASTATIC CARCINOMA RESULTING IN HEPAR LOBATUM

Hepar lobatum is an acquired liver deformity mostly known as the endst age of tertiary syphilis. The authors report two cases of hepar lobatu m resulting from metastatic mammary ductal carcinoma in the liver and reassess the clinicopathologic features of seven previously reported c ases (two in the German language). A liver of near-normal weight with an irregularly lobulated contour, capsular indentations/crevices from which intersecting (carcinoma-bearing) fibrous septa extended deep int o the parenchyma, a predominant centrifugal distribution of Lesional a reas, and many septa abutting on the degenerated center of tumor nodul es were the salient gross features. No significant tumor/fibrous occlu sion of intrahepatic branches of portal or hepatic veins, nor cirrhoti ctype nodular hepatocellular regeneration was observed. Both of these patients experienced a drastic decrease in CEA serum levels during mul tiagent palliative chemotherapy. In one patient, abundant macrophages in conjunction with minimal residual tumor were present within intrahe patic septa. The pathogenesis of this condition appears largely relate d to an active phase of chemo-induced tumor regression with subsequent tissue collapse, followed by an organizing phase of healing and scar contraction.