A woman shows symptoms of massive pulmonary thromboembolism. The gross appearance of liver autopsy is shown. Which of the following statement best characterizes the patient’s condition?
Step 1: Pattern recognition first. Numerous separate rounded tumour nodules studding the whole liver is the hallmark of secondary deposits. A multifocal, multinodular liver is a metastatic liver, not a primary cancer. Step 2: Identify the likely primary. Organs draining through the portal vein seed the liver preferentially, and colorectal carcinoma is the leading source, with liver metastases found in roughly 10 to 25 percent of patients operated for primary colorectal disease. The multinodular gross picture therefore best fits colonic adenocarcinoma that has spread to the liver. Step 3: Exclude the alternatives. A massive pulmonary thromboembolism is a blood clot, which cannot metastasise, so metastasis from PE is nonsensical. Hepatic angiosarcoma produces ill-defined haemorrhagic, blood-filled tissue rather than crisp tumour nodules. Hepatocellular carcinoma classically presents as one dominant cirrhosis-associated mass with local invasion, not as scattered equal-sized deposits. Step 4: Because resection works best when colorectal liver metastasis is confined to the liver, recognising this pattern guides management. The condition is colonic adenocarcinoma with metastasis.\[\boxed{\text{Colonic adenocarcinoma with metastasis}}\]
