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. 2017 Sep 7;12(9):e0183883. doi: 10.1371/journal.pone.0183883

Fig 8. Conceptual pathogenesis of cancer metastasis.

Fig 8

Primary metastasis: Invasion of Kaisopositive and Kaisodepleted mammary carcinoma cells of the local veins and lymphatics allows the cells to migrate via the right heart ventricle to the lung where they are trapped in the capillary blood vessels (b.v.) and form pulmonary metastases. While in the lung, Kaisopositive cells proliferate successfully and form large, coalescing masses that send the cells to actively cross the wall of adjacent blood vessels and invade their lumen. Kaisodepleted tumor cells form small aggregations that do not invade blood vessels therefore the secondary metastases do not occur. Secondary metastasis: The intravascular invasion by the Kaisopositive tumor cells in the lung presumably leads to its migration in the blood via the left heart to a variety of organs notably heart, liver and kidney, where they form metastases and tumors with the invasion of local blood vessels or heart ventricles in a fashion similar to that observed in the lung. This may lead to tertiary metastases; via the venous flow to the right heart and ultimately to the lung.