The most common extrahepatic metastasis of primary carcinoma of the liver is pulmonary metastasis. The discrepancy in the incidence of metastasis between clinical and postmortem series is quite obvious. The rapidly fatal course of hepatoma, the limitations of the chest x-ray film in detecting the small implantation, and incomplete follow-up of patients leads to the lower incidence in clinical series. From January 1974 to December 1982, there were 470 cases of primary carcinoma of the liver at Taipei Municipal Jen-Ai Hospital. Among them, we found 439 cases of hepatocellular carcinoma and 31 cases of cholangiocellular carcinoma. We also found 50 cases (11 percent) of hepatocellular carcinoma with pulmonary metastasis and ten cases (2 percent) of - hepatocellular carcinoma with bone metastasis. Seven of the ten cases of bone metastasis were intrathoracic. Additionally, we found that it was rare to have pulmonary metastasis in cholangiocellular carcinoma; it only occurred once. Hematogenous and lymphatic spread and direct invasion are the principal ways for metastasis in primary hepatoma. Multiple nodulation and pleural effusion are the main manifestations in the chest x-ray film. Additionally, we saw lymphangitic carcinomatosis and miliary lesions in some of our patients. The common characteristic of these metastases is that most of the lesions arise from or are prominent in the right lower pulmonary field. Osteolysis appears in the patients with bone metastasis. Most of the metastases form - a big protruding mass of tumor.
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