February 1989, Volume 39, Issue 2

Short Reports


Qamar Jamal  ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Naeem A. Jafarey  ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
S. Mahmood Alam  ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Tahir N. Khan  ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Sarwar J. Zuberi  ( Pakistan Medical Research Council Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )

Primary carcinoma of the liver is common in Africans and Orients, accounting for 17 to 23% of all malignancies. In America it represents 1.5 to 2.0% of all malignancies.1 Liver tumours, though not the first ten commonest tumours in Pakistan, yet account for 3.7% of all malignancies2. Unusual tumours of the liver have variable origin and are even rarer3 yet it is important to recognize them because they grow slowly, metas­tasize late and therefore are amenable to surgical excision: hence they have better prognosis than hepatocellular and cholangiocarcinoma. 1,3-15 The purpose of this study was to review the various liver tumours in the present series and to assess their frequencies.


Six thousand three hundred and twenty one liver biopsies (needle and open biopsies) were received in the Department of Pathology, Basic Medical Sciences Institute, Jinnah Post­graduate Medical Centre, Karachi, during 27 years (1960—1987). The biopsies were received from various departments of the hospital and institutes outside the hospital. Of the total, only 5,308 biopsies (85%) were adequate enough for histo­pathological reporting. The tissue originally fixed in 10% formalin was processe4 and stained for light microscopic examination. Besides routine haematoxyline and eosin stain, special stains like Masson’s trichrome, Periodic Acid Schiff (PAS) and Gomori’s Silver Stain were used where necessary. Immunofluo­rescence, electron microscopy, immunoperoxi­dase and marker studies could not be done due to non availability of these facilities. Twenty seven biopsies (43%) of unusual primary liver tumours were received, of which 7 (1.1%) were benign and 20 (3.2%) were malig­nant. There were 18 males and 9 females and their ages ranged from 9 months to 75 years with 10 children under the age of 14 years. Various types of benign and malignant unusual liver tumours are shown in Table-I.


The human liver as a consequence of its anatomic location, dual blood supply and size, is a favourable site for neoplastic lesions which are greater in number and diversity than in any other organ. The advent of needle biopsy and other techniques has made diagnosis easier. In literature, unusual types of liver tumours are mostly reported as case reports1,4-16 In the present series 27 cases of unusual liver turnouts are reporteth their frequency among 625 primary liver turnouts is 4.3% and among 5,308 total liver biopsies is 0.5% A frequency of 5.8% among 137 primary liver tumours was reported by El-Demori17 compared to 43% reported by us. On the other hand a high frequency of benign liver tumours was reported by Edmondson18,19, hence in a series of 50,000 autopsies there were 285 (0.6%) hepatic turnouts and out of these 200 (70%) were benign and 95 (30%) were malignant. Of the latter there was only one case of unusual type of malignant tumour.
Benign tumours of the liver are rare com­prising approximately 5% of all primary hepatic neo­plasms20,21. In the present series the frequency is 1.1% of all the primary hepatic turnouts. The commoner variants of benign neoplasms of the liver are (a) liver cell adenoma, (b) bile duct adenoma and (c) haemangioma. The less common ones are neurofibrorna, neurilemmoma and hae­mangio endothelioma18-23. Liver cell adenoma resembles normal liver tissue but the cells are arranged in two to three cell wide trabeculae. Bile canaliculi are absent though bile ducts are present. it may or may not be capsulated. Wide variation of age is en­countered. Those seen in females are often related to the long term use of the contraceptive pills23. In the present series none was of the latter type. Bile duct adenoma is also very rare and is usually discovered incidentally because of its small size (< 1cm) 23. Wide variation of age is seen. Haemangioma, usually cavernous is the com­monest of the benign tumours. Infantile haernan­gio endothelioma type—I & 2 are not related to polyvinyl chloride. Type—i shows endothelial lined spaces. The cells are single layered and cuboid. Type-2 shows multilayering and mitotic figures. The latter is often confused with anglo-sarcomas23.
Hepatoblastoma is the primary liver cell tumour of the childhood. Ishak23 has described three variants viz. Epithelial (foetal and em­bryoma), Epithelial and mesenchymal and un­differentiated in which cartilage bone etc may be seen. Prognosis is best in epithelial (foetal) type. In an autopsy based study Clatworthy20 reported 12 hepatoblastomas (0.7%) among 1,728 malignancies in children.
Primary leiomyosarcoma4,5 is a rare lesion and only ten cases have been reported so far. Their ages ranged from 32 to 63 years and male to female ratio was 2:1. In the present series one of the patients was 21 year old (the youngest case reported so far) and male to female ratio was 1:2.
Like primary leiomyosarcoma of the llver fibrosarcoma too, is an extremely rare neoplasm. Totzke, 7 Shallow8 and Jaffe9 have reported one case each and Simpson has reported three cases of primary fib rosarcoma of the liver. Amongst the reported cases, the ages of the patients ranged from 55 to 65 years and male to female ratio was approximately 1:1 Steiner24 reported 0.1% frequency among 860 primary hepatic malignan. cies. In the present series the frequency is 0.3% among 619 primary hepatic malignancies.
Primary melanosarcoma of the liver is mentioned in the classification of liver tumours by Edmondson18 and Spellberg, 22 however no case report was available in the literature. In the present series three cases are reported on the pre­sumption that primary was not detected else­where.
Squamous Cell Carcinoma:
Diagnosis of this case was also based upon exclusion viz, primary was not located any where else. Though Edmondson has quoted primary squamous cell carcinoma in his classification on liver tumours but any published report on this subject could not be found.


1.  Wilson, S.E., Braitman, H., Plested, W.G. and Longmire, W. P.Jr. Primary leiomyosarcoma of the liver. Ann. Surg., 1971; 174:994.
2.  Pakistan Medical Research Council Malignant Tumours; report of a multicentre study.
3.  Sherlock, S. Diseases of the liver and biliary system. 6th ed.Oxford, Blackweli, 1981, p. 468.
4.  Masur, H., Sussman, E.B. and Molander, D.W. Primary hepatic leiomyosarcoma: A report of two cases. Gastroenterology, 1975; 69:994.
5.  Chen, K.T. Hepatic leiomyosarcoma. J. Surg. Oncol., 1983; 24:325.
6.  Goldman, R.L., Friedman, N.E. Rhabdomyo­sarchepatoma in an adult and embryonal hepatoma in a child. Am. J. Clin. Pathol., 1969;51: 137.
7.  Totzke, H.A. and Hutcheson, LB. Primary fibrosarcoma of the liver. Southern Med. J., 1965; 58:237.
8.  Shallow, T.A. and Wagner, F$. Primary fibrosar­coma of the liver. Ann. Surg., 1947; 125:439.
9.  Jaffe, R.H. Sarcoma and carcinoma of the liver following cirrhosis. Arch. Intern. Med., 1924; 33:30.
10. Simpson, H.M. Jr., Baggenstoss, A.H. and Stauffen, M.H. Primary sarcoma of the liver; a report of three cases. Southern Med. J., 1955; 48; 1177.
11. Tsuchida, Y., Yokomori, K., Saito, S., Kaku, H. and Bessho, F. Stage IV - 5 neuroblastoma involving the liver and the ectopic liver; report of an unusual case. Cancer , 1984; 53 : 1609.
12. Hart, W.R. Primary endodermal sinus (yolk sac) tumour of the liver; first reportcd ease. Cancer, 1975; 35:1453.
13. Rabin, F., Russinovich, N.A.E., Luna, R.F., Tishler, J.M.A. and Wilkinson, LA. Myelolipoma of the liver. Cancer, 1984; 54:2043.
14. Kurchamman, PJ. Hepatic pseudolipoma, J. Clin. Pathol., 1985; 38:877.
15. Peters, W.M., Dixon, M.F. and Williams, N.S. Anglo myolipoma of the liver. Histopathology, 1983; 7:99.
16. Ponder, D.J. Hepatic angiomyolipoma. Am. J. Surg. Pathol., 1982;6 :677.
17. El-Domeiri, A.A., Huvos, A.G., Goldsmith, H.S., Foote, F.W. Jr. Primary malignant tumours of the liver. Cancer, 1971; 27:7.
18. Edmondson, H.A. Tumours of the liver and intrahepatic bile ducts, in atlas of tumour of pathology, Seel fascicles 25, Washington, Armed Forces Institute of Patnology, 1958.
19. Edmondson, H.A. Differential diagnosis of tumours and tumour-like lesions of liver in infancy and childhood. Am. J. Dis. Child., 1956; 91:168.
20. Clatworthy, H.W. Jr., Boles, LIT. Jr. and Kott meier, P.K. Liver tumours in infancy and child­hood. Ann. Surg., 1961; 154:475.
21. Macsween, R.N.M. Tumours of the liver, in Muir’s text book of pathology. Edited by J.R. Andesson. 12th ed. Bradford, Edward Arnold, 1985, sec. 20:39.
22. Spellberg, M.A. Classification of the neoplasms of the liver, in diseases of the liver. By Mitchell A. Speliberg. New York, Crune and Stratton, 1954; p. 128.
23. Ishaq, K.G. New development in diagnostic liver pathology, in pathogenesis of liver diseases. IAP Monograph No. 28. Baltimore Williams and Wilkins, p. 312.
24. Steiner, P.E. Canber of the liver and cirrhosis in Trans-Saharan Africa and the United States of America. Cancer, 1960; 13; 1085.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: