CASE HISTORY

The patient who did not take alcohol, was healthy until 1 year before death when she  developed "rheumatic" pains in her legs. Six later her belly began to swell and she developed dyspnoea. Three months later her ankles and legs began to swell. On admission she was faintly icteric and had a grossly distended belly. Her legs and back were oedematous and the jugular venous pressure was slightly raised. The abdomen was tapped and 35 pints of clear fluid was removed. Within a week of admission patient had passed into cholaemia and she died four days later.

PATHOLOGY

The posterior half of the liver has been mounted. It is slightly shrunken and its outer surface is coarsely nodular. On the cut surface the left lobe shows coarse Laennec's cirrhosis with irregular sized, rounded nodules of pale liver tissue embedded in a stroma of translucent grey fibrous tissue. The majority of the right lobe is replaced by a pinkish white carcinoma containing irregular white areas of necrosis. On the posterior surface the portal vein has been laid open and is seen to be full of tumour which has grown out from the liver. A similar mass  of tumour can be seen growing into the lumen of the hepatic vein at the top of the specimen.