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* Benign tumours are more common in cats
* Benign tumours are more common in cats
* Malignant primary tumours include:
* Malignant primary tumours include:
** [[Liver Proliferative - Pathology #Hepatocytic|Hepatocellular carcinoma]] - the most common primary liver tumour in dogs and the second most common in cats
** [[Liver Proliferative - Pathology #Hepatocytic|Hepatocellular carcinoma]]
** [[Liver Proliferative - Pathology #Cholangiocellular|Cholangiocellular carcinoma]]
** [[Liver Proliferative - Pathology #Cholangiocellular|Cholangiocellular carcinoma]]
** Gall bladder carcinoma
** Gall bladder carcinoma
** [[Liver Proliferative - Pathology #Cholangiocellular|Cholangiocellular adenoma]]
** [[Liver Proliferative - Pathology #Cholangiocellular|Cholangiocellular adenoma]]
** Gall bladder adenoma
** Gall bladder adenoma
Note: Distinction must be made between all hepatic tumours and benign nodular hyperplasia frequently observed in the older canine. The most significant primary tumours in the dog are hepatomas, hepatocellular and cholangiocellular carcinomas and hepatic carcinoids. Hepatocellular carcinomas and cholangiocarcinomas are the most significant in cats.
Note: Distinction must be made between all hepatic tumours and benign nodular hyperplasia that is frequently observed in the older canine. The most significant primary tumours in the dog are hepatomas, hepatocellular and cholangiocellular carcinomas and hepatic carcinoids. Hepatocellular carcinomas and cholangiocellular carcinomas are the most significant in cats.
** Ascites
** Ascites
* Neurological Signs - seizures, ataxia and weakness occur less frequently. They may be due to metastasis to the central nervous system, hepatic encephalopathy or hypglycaemia which can occur as a paraneoplastic syndrome
* Neurological Signs - seizures, ataxia and weakness occur less frequently. They may be due to metastasis to the central nervous system, hepatic encephalopathy or hypglycaemia which can occur as a paraneoplastic syndrome
* Icterus - Particularly in dogs with extrahepatic cholangiocarcinomas and diffuse carcinoids
* Icterus - Particularly in dogs with extrahepatic cholangiocellular carcinomas and diffuse carcinoids
===Physical Examination===
===Physical Examination===
===Haematology and Biochemistry===
===Haematology and Biochemistry===
* Usually non-specific. The following are frequently observed in dogs:
* Usually non-specific. The following are frequently observed in dogs:
** Mild non-regenerative anaemia - cause idiopathic, however, anaemia of chronic disease, inflammation, red blood cell sequestration and iron deficiency may play roles
** Mild non-regenerative anaemia - cause idiopathic, however anaemia of chronic disease, inflammation, red blood cell sequestration and iron deficiency may play roles
** Leukocytosis - resulting from the associated inflammation and necrosis with large liver masses
** Leukocytosis - resulting from the associated inflammation and necrosis that can occur with large liver masses
** Thrombocytosis - potential causes include production of thrombopoietin as a parneoplastic syndrome, iron deficiency, inflammatory cytokines and anaemia
** Thrombocytosis - potential causes include production of thrombopoietin as a parneoplastic syndrome, iron deficiency, inflammatory cytokines and anaemia
* Elevated hepatic enzymes - likely due to hepatocellular damage or biliary stasis though the level of enzyme increase is not proportional to severity of liver damage
* Elevated hepatic enzymes - likely due to hepatocellular damage or biliary stasis though the extent of enzyme increase is not proportional to severity of liver damage
* Hypoalbuminaemia
* Hypoalbuminaemia
* Hyperglobulinaemia
* Hyperglobulinaemia
* Hypoglycaemia - can occur as a paraneoplastic syndrome where there is increased utilisation of glucose or increased produciton of hormones with insulin-like activity.
* Hypoglycaemia - can occur as a paraneoplastic syndrome where there is increased utilisation of glucose or increased production of hormones with insulin-like activity.
* Elevated pre- and postprandial bile acids
* Elevated pre- and postprandial bile acids
** Azotaemia
** Azotaemia
** Elevated hepatic enzymes
** Elevated hepatic enzymes
** Elevated bilirubin
** Elevated serum bilirubin - particularly in those with hepatocellular carcinoma
===Plain Abdominal Radiography===
===Plain Abdominal Radiography===
Hepatomegaly, rounding of the margins of the liver and a cranial abdominal mass may be observed with displacement of the stomach caudally and laterally with massive hepatic neoplasms. Occasionally mineralisation of the biliary tree is observed in dogs with cholangiocellular carcinoma. Three thoracic views should also be taken to assess lung metastasis although this is uncommon at the time of diagnosis.
Hepatomegaly and rounding of the margins of the liver may be observed. Alternatively a cranial abdominal mass may be visible with displacement of the stomach caudally and laterally with massive hepatic neoplasms. Occasionally mineralisation of the biliary tree is observed in dogs with cholangiocellular carcinoma. Three thoracic views should also be taken to assess lung metastasis although this is uncommon at the time of diagnosis.
===Ultrasonography===
===Ultrasonography===
Advised to evaluate the condition of surrounding structures. It also allows classification of the mass as massive, nodular or diffuse. Doppler techniques can also be utilised to assess the vascular structure of tumours. Guided fine-needle aspirates or core biopsies can also be taken at this time (a coagulation profile is highly recommended prior to performing a liver biopsy due to risk of haemorrhage). If the lesion is solitary and massive surgical resection without preoperative biopsy is usually undertaken as diagnosis and treatemnt are accomplished in one procedure.
===Advanced Imaging===
===Advanced Imaging===
==Signalment and Description==
==Signalment and Description==
===Hepatocellular Tumours (Hepatocellular carcinomas (HCC) and Hepatomas)===
===Hepatocellular Tumours (Hepatocellular carcinomas (HCC) and Hepatomas)===
* HCC occurs more frequently in dogs and hepatomas more commonly in cats. Male dogs over 10 years old are the most frequently affected. Miniature schnauzers may have a breed predisposition.
* HCC occurs more frequently in dogs and hepatomas more commonly in cats. They are the most common primary liver tumour in dogs and the second most common in cats.
* Male dogs over 10 years old are the most frequently affected by HCC and Miniature schnauzers may have a breed predisposition.
* Regional lymph nodes (hepatic and diaphragmatic nodes), peritoneum and lungs are the most frequent sites of metastasis in dogs with nodular and diffuse HCC.
* Regional lymph nodes (hepatic and diaphragmatic nodes), peritoneum and lungs are the most frequent sites of metastasis in dogs with nodular and diffuse HCC.
* Metastatic rate for dogs with massive HCC: 0-37%
* Metastatic rate for dogs with massive HCC: 0-37%
* Hepatomas are usually incidental findings and non-significant
* Hepatomas are usually incidental findings and non-significant
===Cholangiocellular Tumours (Bile duct carcinomas and adenomas)===
===Cholangiocellular Tumours (Bile duct carcinomas and adenomas)===
* Bile duct carcinomas are the most common malignant hepatobillary tumours in cats and the second most frequent in dogs, particularly females
* Bile duct carcinomas are the most common malignant hepatobillary tumours in cats and the second most frequent in dogs and females may be predisposed
* Intrahepatic carcinomas are more frequent in dogs. In cats there have been reports of both equal levels of occurrence of intra-and extrahepatic tumours and of a a extrahepatic dominance.
* Intrahepatic carcinomas are more frequent in dogs. In cats there have been reports of both equal occurrence of intra-and extrahepatic tumours and of a extrahepatic dominance.
* Bile duct carcinomas are aggressive with metastasis to particularly the regional lymph nodes and lungs frequently being observed in dogs and diffuse intraperitoneal metastasis and carcinomatosis being common in cats.
* Bile duct carcinomas are aggressive with metastasis to particularly the regional lymph nodes and lungs frequently being observed in dogs and diffuse intraperitoneal metastasis and carcinomatosis being common in cats.
* Bile duct adenomas (also known as biliary or hepatobiliary cystadenomas) are common in cats, particularly males.
* Bile duct adenomas (also known as biliary or hepatobiliary cystadenomas) are common in cats, particularly males.
===Carcinoids (Neuroendocrine Tumours)===
===Carcinoids (Neuroendocrine Tumours)===
* Usually occur in younger animals compared with other primary hepatobiliary tumours.
* Usually occur in younger animals compared with other primary hepatobiliary tumours.
* Primary tumours are aggressive and often affect more than one liver lobe and metastasise to most frequently the regional lymph nodes, the lungs and peritoneum.
* Primary tumours are aggressive and often affect more than one liver lobe and metastasise most frequently to the regional lymph nodes, the lungs and peritoneum.
===Sarcomas (Haemangiosarcoma (HSA), Leiomyosarcoma, Fibrosarcoma)===
===Sarcomas (Haemangiosarcoma (HSA), Leiomyosarcoma, Fibrosarcoma)===
===Chemotherpay===
===Chemotherpay===
Not currently recommended for primary hepatic neoplasia. Some metastatic sarcomas for example haemangiosarcomas may show some response.
Not currently recommended for primary hepatic neoplasia. Some metastatic sarcomas, for example haemangiosarcomas, may show some response.
===Radiotherapy===
===Radiotherapy===
Not reported. Surrounding abdomina organs may show poor tolerance.
Not reported. Surrounding abdominal organs may show poor tolerance.
==References==
==References==