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Deng L, Lin S, Chen Y, Zhong H, Leng X, Lin Z, Duan S, Chen F. Analysis of clinical and imaging characteristics of pseudocirrhosis in breast cancer liver metastasis. Eur J Radiol 2025; 185:112008. [PMID: 40022838 DOI: 10.1016/j.ejrad.2025.112008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 02/06/2025] [Accepted: 02/19/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND Pseudocirrhosis that may be triggered by the treatment of breast cancer liver metastasis often begins insidiously and progresses rapidly. This complicates the accurate assessment of tumor growth or regression. Without timely intervention, patients are at significant risk of death due to acute liver failure or bleeding from ruptured varices. OBJECTIVE This study aims to explore the clinical and radiological characteristics of pseudocirrhosis, providing a theoretical basis for clinicians to facilitate early diagnosis and treatment, thereby reducing the misdiagnosis rate and mortality associated with this condition. METHODS This study conducted a retrospective analysis of clinical data and CT and MRI images from 32 patients (the pseudocirrhosis group) with pathologically confirmed breast cancer liver metastasis and radiological features of pseudocirrhosis, and 28 patients (the control group) with breast cancer liver metastasis without pseudocirrhosis, at the First Affiliated Hospital of Zhejiang University from November 2012 to January 2024. All patients were female, with an average age of 58.3 ± 8.3 years in the pseudocirrhosis group and 56.5 ± 7.8 years in the control group. In the pseudocirrhosis group, 27 patients underwent CT scans and 23 underwent routine MRI examinations. In the control group, 24 patients underwent CT scans and 20 underwent routine MRI examinations. Image analysis included the number of lesions, morphology, enhancement patterns, degree of liver capsule retraction, presence of portal hypertension, gastric varices, ascites, and abnormal nodules, as well as an analysis of patients' chemotherapy regimens, prothrombin time (PT), albumin, and cholinesterase levels. RESULTS In our study, liver metastases in both the pseudocirrhosis group and the control group were multiple and round-shaped, with enhanced lesions exhibiting moderate to marked ring or nodular enhancement. Among the 32 cases in the pseudocirrhosis group, one patient presented with multiple liver metastases and the development of pseudocirrhosis at initial diagnosis, while the remaining 31 patients developed pseudocirrhosis following chemotherapy or combined therapy. No abnormal nodules, were observed in either group aside from the metastatic tumors. In the pseudocirrhosis group, portal vein thickening was observed in 2 cases (6.3 %), ascites in 18 cases (56.3 %), splenomegaly in 11 cases (34.4 %), and gastric varices in 3 cases (9.4 %). The liver capsule retraction was classified as diffuse in 14 cases (43.7 %), extensive in 10 cases (31.3 %), and limited in 8 cases (25.0 %). Among the 24 patients with available laboratory data, the prothrombin time (PT) was normal in 21 cases (65.6 %) and prolonged in 3 cases (9.4 %), albumin levels were normal in 14 cases (58.3 %) and decreased in 10 cases (41.3 %), and cholinesterase levels were normal in 23 cases (95.8 %) with a decrease in 1 case (4.2 %). The control group showed no signs of portal hypertension or its decompensated manifestations; among the 26 patients with available data, albumin levels were normal in 18 cases (69.2 %) and decreased in 8 cases (30.8 %); PT was normal in 24 cases (92.3 %) and prolonged in 2 cases (7.7 %); cholinesterase levels were normal in 27 cases (96.4 %) with a decrease in 1 case (3.6 %). CONCLUSION Chemotherapy or combined therapy may be a triggering factor for the development of pseudocirrhosis in patients with breast cancer liver metastasis. In the early stages of pseudocirrhosis, liver synthetic function does not appear to be significantly affected.
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Affiliation(s)
- Lizhu Deng
- Radiology Department of Zhongshan Hospital, affiliated to Xiamen University, Xiamen University, Xiamen, China
| | - Simin Lin
- Radiology Department of Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yangyang Chen
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang,China
| | - Hua Zhong
- Radiology Department of Zhongshan Hospital, affiliated to Xiamen University, Xiamen University, Xiamen, China
| | - Xiaoyuan Leng
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhanghua Lin
- Radiology Department of Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Shaoyin Duan
- Radiology Department of Zhongshan Hospital, affiliated to Xiamen University, Xiamen University, Xiamen, China
| | - Feng Chen
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Phillips E, Sethi M, Vasanthakumar S, Sherpa G, Johnston S, Parton M, Kipps E, Turner NC, Foxton M, Okines A. The Clinical Features and Outcomes of Pseudocirrhosis in Breast Cancer. Cancers (Basel) 2024; 16:2822. [PMID: 39199595 PMCID: PMC11352314 DOI: 10.3390/cancers16162822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
Pseudocirrhosis is a diffuse nodularity of the liver that radiologically mimics cirrhosis but is a distinct pathological process. It is seen almost exclusively in patients with liver metastases and may represent a response to systemic treatment. Data on the risk factors for pseudocirrhosis and outcomes are limited. In total, 170 patients with a diagnosis of breast cancer and pseudocirrhosis in a 10-year period were identified and retrospectively analysed. Data were collected on baseline patient characteristics, treatments received, and outcomes. Median time between diagnosis of liver metastases and diagnosis of pseudocirrhosis was 17.1 months (range, 0-149 months). In total, 89.4% of patients received chemotherapy between their diagnosis of breast cancer liver metastases and their diagnosis of pseudocirrhosis, most commonly a taxane (74.7%) or capecitabine (67.1%), and the median treatment lines received was 3. Median OS from first diagnosis of pseudocirrhosis was 7.6 months (95% CI: 6.1-9.6 months) and was longer in patients with HER2+ disease at 16.7 months (95% CI: 6.4-32.9 months), which was statistically significant. In our study, pseudocirrhosis occurred in the presence of liver metastases and was associated with a poor prognosis. HER2+ patients with pseudocirrhosis had a better prognosis than other subtypes, but we did not identify other significant predictors of survival. Chemotherapy was not a prerequisite for pseudocirrhosis development, although the majority of patients had received at least one line of chemotherapy before pseudocirrhosis was diagnosed.
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Affiliation(s)
- Edward Phillips
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
| | - Mantegh Sethi
- Department of Surgery, University Hospitals Birmingham, Birmingham B15 2GW, UK;
| | | | - Gina Sherpa
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
| | - Stephen Johnston
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
| | - Marina Parton
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
| | - Emma Kipps
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
| | - Nicholas C. Turner
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
| | - Matthew Foxton
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
- Department of Gastroenterology, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Alicia Okines
- Breast Unit, The Royal Marsden Hospital, London SW3 6JJ, UK; (E.P.); (S.V.); (G.S.)
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Sadlik G, Anderson RC, Lei X, Cen SY, Duddalwar VA, Fong TL. Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature. Dig Dis Sci 2024; 69:1004-1014. [PMID: 38175453 PMCID: PMC10960760 DOI: 10.1007/s10620-023-08226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Pseudocirrhosis is a poorly understood acquired morphologic change of the liver that occurs in the setting of metastatic malignancy and radiographically resembles cirrhosis. Pseudocirrhosis has been primarily described in metastatic breast carcinoma, with few case reports arising from other primary malignancies. We present 29 cases of pseudocirrhosis, including several cases from primary malignancies not previously described. METHODS Radiologic, clinical, demographic, and biomedical data were collected retrospectively and analyzed. We compared clinical and radiologic characteristics and outcomes between patients with pseudocirrhosis arising in metastatic breast cancer and non-breast primary malignancies. RESULTS Among the 29 patients, 14 had breast cancer and 15 had non-breast primaries including previously never reported primaries associated with pseudocirrhosis, melanoma, renal cell carcinoma, appendiceal carcinoid, and cholangiocarcinoma. Median time from cancer diagnosis to development of pseudocirrhosis was 80.8 months for patients with primary breast cancer and 29.8 months for non-breast primary (p = 0.02). Among all patients, 15 (52%) had radiographic features of portal hypertension. Radiographic evidence of portal hypertension was identified in 28.6% of breast cancer patients, compared to 73.3% of those with non-breast malignancies (p = 0.03). CONCLUSION Pseudocirrhosis has most commonly been described in the setting of metastatic breast cancer but occurs in any metastatic disease to the liver. Our study suggests that portal hypertensive complications are more common in the setting of non-breast primary cancers than in metastatic breast cancer. Prior exposure to multiple chemotherapeutic agents, and agents known to cause sinusoidal injury, is a common feature but not essential for the development of pseudocirrhosis.
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Affiliation(s)
- Gal Sadlik
- Department of Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Redmond-Craig Anderson
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Xiaomeng Lei
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Steven Yong Cen
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Vinay A Duddalwar
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tse-Ling Fong
- Liver Program, Hoag Digestive Health Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA.
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Fichtl A, Seufferlein T, Zizer E. Risks and benefits of TIPS in HCC and other liver malignancies: a literature review. BMC Gastroenterol 2023; 23:403. [PMID: 37986043 PMCID: PMC10662760 DOI: 10.1186/s12876-023-03047-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated treatment option for clinically significant portal hypertension (CSPH) in the context of liver cirrhosis. Its high efficacy and safety in the management of treatment-refractory ascites and variceal bleeding have been extensively proven. Contraindications for TIPS include severe right heart failure, hepatic encephalopathy, and sepsis. However, the role of liver malignancy in TIPS is debatable. Mostly, primary liver malignancies such as hepatocellular carcinoma (HCC) emerge from advanced liver diseases. Coexisting portal hypertension in HCC often results in limited treatment options and a poor prognosis. Previous studies have shown that TIPS implantation in patients with HCC is technically feasible and is usually not associated with major adverse events. Furthermore, TIPS may help in bridging the time to liver transplantation in early HCC and allow for locoregional treatment in advanced HCC. However, several studies suggest that seeding tumour cells to the lungs by TIPS placement might worsen the prognosis. CONCLUSIONS TIPS placement in patients with coexisting liver malignancy remains a case-by-case decision, and there is no profound evidence allowing general recommendations. This review aims to provide a state-of-the-art overview of the potential risks and benefits of TIPS placement in patients with liver malignancies.
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Affiliation(s)
- Anna Fichtl
- Department of Gastroenterology and Hepatology Internal Medicine I, University Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Thomas Seufferlein
- Department of Gastroenterology and Hepatology Internal Medicine I, University Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Eugen Zizer
- Department of Gastroenterology and Hepatology Internal Medicine I, University Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
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Pope MC, Olson MC, Flicek KT, Patel NJ, Bolan CW, Menias CO, Wang Z, Venkatesh SK. Chemotherapy-associated liver morphological changes in hepatic metastases (CALMCHeM). Diagn Interv Radiol 2023; 29:571-578. [PMID: 37310196 PMCID: PMC10679643 DOI: 10.4274/dir.2023.232299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE To review imaging findings in chemotherapy-associated liver morphological changes in hepatic metastases (CALMCHeM) on computed tomography (CT)/magnetic resonance imaging (MRI) and its association with tumor burden. METHODS We performed a retrospective chart review to identify patients with hepatic metastases who received chemotherapy and subsequent follow-up imaging where CT or MRI showed morphological changes in the liver. The morphological changes searched for were nodularity, capsular retraction, hypodense fibrotic bands, lobulated outline, atrophy or hypertrophy of segments or lobes, widened fissures, and one or more features of portal hypertension (splenomegaly/venous collaterals/ascites). The inclusion criteria were as follows: a) no known chronic liver disease; b) availability of CT or MRI images before chemotherapy that showed no morphological signs of chronic liver disease; c) at least one follow-up CT or MRI image demonstrating CALMCHeM after chemotherapy. Two radiologists in consensus graded the initial hepatic metastases tumor burden according to number (≤10 and >10), lobe distribution (single or both lobes), and liver parenchyma volume affected (<50%, or ≥50%). Imaging features after treatment were graded according to a pre-defined qualitative assessment scale of "normal," "mild," "moderate," or "severe." Descriptive statistics were performed with binary groups based on the number, lobar distribution, type, and volume of the liver affected. Chi-square and t-tests were used for comparative statistics. The Cox proportional hazard model was used to determine the association between severe CALMCHeM changes and age, sex, tumor burden, and primary carcinoma type. RESULTS A total of 219 patients met the inclusion criteria. The most common primaries were from breast (58.4%), colorectal (14.2%), and neuroendocrine (11.0%) carcinomas. Hepatic metastases were discrete in 54.8% of cases, confluent in 38.8%, and diffuse in 6.4%. The number of metastases was >10 in 64.4% of patients. The volume of liver involved was <50% in 79.8% and ≥50% in 20.2% of cases. The severity of CALMCHeM at the first imaging follow-up was associated with a larger number of metastases (P = 0.002) and volume of the liver affected (P = 0.015). The severity of CALMCHeM had progressed to moderate to severe changes in 85.9% of patients, and 72.5% of patients had one or more features of portal hypertension at the last follow-up. The most common features at the final follow-up were nodularity (95.0%), capsular retraction (93.4%), atrophy (66.2%), and ascites (65.7%). The Cox proportional hazard model showed metastases affected ≥50% of the liver (P = 0.033), and the female gender (P = 0.004) was independently associated with severe CALMCHeM. CONCLUSION CALMCHeM can be observed with a wide variety of malignancies, is progressive in severity, and the severity correlates with the initial metastatic liver disease burden.
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Affiliation(s)
- Matthew C. Pope
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Minnesota, USA
| | - Michael C. Olson
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Minnesota, USA
| | - Kristina T. Flicek
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Minnesota, USA
| | - Neema J. Patel
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Florida, USA
| | - Candice W. Bolan
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Florida, USA
| | - Christine O. Menias
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Arizona, USA
| | - Zhen Wang
- Department of Biostatistics, Mayo Clinic, Minnesota, USA
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Ma WL, Chang DY, Lin CH, Liu KL, Liang PC, Lien HC, Hu CC, Huang LY, Yeh YC, Lu YS. Clinical Outcomes of Metastatic Breast Cancer in Patients Having Imaging Liver Pseudocirrhosis with or without Evident Varices. Oncologist 2022; 27:1008-1015. [PMID: 36215276 DOI: 10.1093/oncolo/oyac199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pseudocirrhosis is an imaging finding of malignancies with liver metastasis with or without clinical liver cirrhosis-related portal hypertension (pHTN). This study defined evident pHTN by the presence of esophageal or gastric varices and compared patients' outcomes of metastatic breast cancer with imaging-diagnosed pseudocirrhosis with or without varices. METHODS The medical records from patients with metastatic breast cancer and pseudocirrhosis between 2005 and 2017 were retrospectively analyzed. Survival outcomes were compared based on endoscopic evidence of esophageal or gastric varices. RESULTS Among 106 patients with pseudocirrhosis, 33 (31%) had de novo stage IV disease, and 66 (62%) had hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Eighty-one (76%) had initial metastases in both hepatic lobes, and 32 (30%) had esophageal or gastric varices. The median overall survival (OS) was 5 and 13 months in patients with and without varices (P = .002). The median OS in patients with HER2-positive, HR-positive/HER2-negative, and triple-negative subtype was 16, 9, and 2 months, respectively (P = .001). Patients with varices usually had cirrhotic complications, including gastrointestinal bleeding, hyperbilirubinemia, hyperammonemia, and coagulopathy. Despite their challenging clinical conditions, 7 patients with varices had OS exceeding 1 year. In multivariate analysis, evident varices (P = .007) and triple-negative subtype (P = .013) were associated with poor OS. CONCLUSIONS Patients with pseudocirrhosis and evident varices had a significantly shorter median OS, and were usually associated with clinical cirrhosis-related complications. To maximize OS, early identification and meticulous supportive care are warranted.
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Affiliation(s)
- Wei-Li Ma
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Dwan-Ying Chang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Oncology, National Taiwan University Cancer Center Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chan-Chuan Hu
- Department of Medical Research and Education, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ling-Yun Huang
- Clinical Trial Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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Villani R, Di Cosimo F, Sangineto M, Romano AD, Serviddio G. Pseudocirrhosis and portal hypertension in patients with metastatic cancers: a systematic review and meta-analysis. Sci Rep 2022; 12:19865. [PMID: 36400809 PMCID: PMC9674682 DOI: 10.1038/s41598-022-24241-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Pseudocirrhosis is a clinical and radiological entity mimicking liver cirrhosis in patients without a history of chronic liver disease. We performed a systematic review and meta-analysis of the current literature to evaluate the state-of-the-art and investigate the epidemiology and clinical features of pseudocirrhosis. We searched PubMed, Web of Science and Scopus for literature published until February 28, 2022. We included in the final analysis 62 articles (N = 389 patients): 51 case reports (N = 64 patients), 5 case series (N = 35 patients) and 6 observational studies (N = 290 patients). About 80% of patients included in the case reports and case series had breast cancer. Most patients had at least one clinical sign of portal hypertension and ascites was the most common clinical manifestation of portal hypertension. The median time from pseudocirrhosis to death was 2 months (IQR 1-7 months). Alkylating agents and antimitotics were the most common classes of anticancer drugs reported in our study population. Notably, about 70% of patients received three or more anticancer drugs. Finally, pseudocirrhosis is a condition that occurs in patients with hepatic metastases and may have a negative impact on survival and clinical management of patients because of the potential development of portal hypertension and its complications.
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Affiliation(s)
- Rosanna Villani
- grid.10796.390000000121049995Liver Unit, C.U.R.E. (University Centre for Liver Disease Research and Treatment), Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Francesca Di Cosimo
- grid.10796.390000000121049995Liver Unit, C.U.R.E. (University Centre for Liver Disease Research and Treatment), Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Moris Sangineto
- grid.10796.390000000121049995Liver Unit, C.U.R.E. (University Centre for Liver Disease Research and Treatment), Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Antonino Davide Romano
- grid.10796.390000000121049995Liver Unit, C.U.R.E. (University Centre for Liver Disease Research and Treatment), Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Gaetano Serviddio
- grid.10796.390000000121049995Liver Unit, C.U.R.E. (University Centre for Liver Disease Research and Treatment), Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
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Pandey R, Khanal S, Neupane S, Dhakal B, Pudasaini P, Khadka S, Adhikari R, Poudel B. Liver metastases - An unusual cause of portal hypertension: A case report. Ann Med Surg (Lond) 2022; 84:104912. [PMID: 36582922 PMCID: PMC9793164 DOI: 10.1016/j.amsu.2022.104912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Portal hypertension is a rare complication of liver metastases. The study highlights that clinician should be aware of conditions mimicking cirrhosis with similar clinical presentation and imaging findings. Case presentation We present the case of a 29-year-old non-alcoholic lady who presented to our hospital with a history of two months of progressive, painless abdominal distension and progressively increasing yellowish discoloration of the eyes. Physical examination, laboratory investigations, and imaging tests led to a diagnosis of multiple metastases from breast carcinoma to the liver leading to portal hypertension after exclusion of other causes of portal hypertension. However, after three weeks of presentation to the hospital, the patient died before any therapeutic measures were initiated to address breast carcinoma. Clinical discussion Liver metastasis from primary breast carcinoma rarely presents with clinical symptoms of portal hypertension. Although portal hypertension secondary to pseudocirrhosis, predominantly linked to ongoing chemotherapy for known cancers, has been previously described in case studies, our case had an unusual presentation leading to diagnostic uncertainty. Conclusion Our case highlights the rare cause of liver metastasis secondary to breast carcinoma, which presented as portal hypertension.
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Affiliation(s)
- Rajesh Pandey
- Department of Internal Medicine, Civil Service Hospital, Kathmandu, Nepal
| | - Sambhu Khanal
- Department of Internal Medicine, Lumbini Provincial Hospital, Butwal, Nepal
| | - Shashank Neupane
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal,Corresponding author. Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal.
| | - Bishal Dhakal
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Prasamsa Pudasaini
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Sabina Khadka
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Rupika Adhikari
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
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Calistri L, Rastrelli V, Nardi C, Maraghelli D, Vidali S, Pietragalla M, Colagrande S. Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis. World J Gastroenterol 2021; 27:7866-7893. [PMID: 35046618 PMCID: PMC8678821 DOI: 10.3748/wjg.v27.i46.7866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, "yellow liver" due to chemotherapy-associated steatosis-steatohepatitis, and "blue liver", including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.
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Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Sofia Vidali
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
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10
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Shinoda T, Tanahashi T, Sakuratani T, Ota M, Fujibayashi S, Kiriyama S, Matsumoto K, Yawata K, Sasaki Y, Osada S, Yamada M. Pseudocirrhosis after chemotherapy for gastric cancer with diffuse liver metastases: A case report. Mol Clin Oncol 2021; 16:11. [PMID: 34881031 PMCID: PMC8647196 DOI: 10.3892/mco.2021.2441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023] Open
Abstract
Pseudocirrhosis is a rare but important complication of metastatic cancer. We herein present the case of a patient with pseudocirrhosis occurring after a complete response to chemotherapy for metastatic gastric cancer was achieved. A 72-year-old man was diagnosed with gastric adenocarcinoma with multiple liver metastases. The patient's general condition was good, with an Eastern Cooperative Oncology Group performance status of 1. Chemotherapy with oxaliplatin and S-1 was initiated and, after four cycles, the patient noticed sudden abdominal distension. Despite the marked regression of the liver metastases, massive ascites, segmental atrophy and esophageal varices developed, findings consistent with pseudocirrhosis. The patient achieved complete response for the primary and metastatic lesions. Following endoscopic ligation of the varices, he underwent subsequent chemotherapy with S-1 only and management of his ascites for 6 months. At 12 months after initial chemotherapy, the patient appeared to be disease-free. In conclusion, clinicians should be aware of the possibility of pseudocirrhosis in cases of cancer metastasis to the liver, including metastatic gastric cancer.
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Affiliation(s)
- Tomohito Shinoda
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | | | - Takuji Sakuratani
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Masato Ota
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Seito Fujibayashi
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Shunya Kiriyama
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Keita Matsumoto
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Kazunori Yawata
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Yoshiyuki Sasaki
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Shinji Osada
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
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11
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Morshid A, Szklaruk J, Yacoub JH, Elsayes KM. Errors and Misinterpretations in Imaging of Chronic Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:419-436. [PMID: 34243927 DOI: 10.1016/j.mric.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
MRI is an important problem-solving tool for accurate characterization of liver lesions. Chronic liver disease alters the typical imaging characteristics and complicates liver imaging. Awareness of imaging pitfalls and technical artifacts and ways to mitigate them allows for more accurate and timely diagnosis.
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Affiliation(s)
- Ali Morshid
- Department of Diagnostic Radiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Joseph H Yacoub
- Department of Radiology, Medstar Georgetown University Hospital, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
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12
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Nakano S, Suzuki T, Takase Y, Ito M, Osaki T, Yoshii A, Terauchi T. Pseudocirrhosis caused by lung adenocarcinoma with diffuse liver metastasis: An autopsy case report. Thorac Cancer 2021; 12:2046-2049. [PMID: 34008335 PMCID: PMC8258366 DOI: 10.1111/1759-7714.14010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022] Open
Abstract
We describe a rare case of a 64-year-old man with lung adenocarcinoma with lymph node and bone metastases who developed pseudocirrhosis. Initial examination revealed a hepatic disorder of unknown cause with narrowing of the portal vein and a low-density area surrounding the portal veins in computed tomography (CT) imaging. Diffuse liver metastasis was diagnosed after percutaneous liver biopsy. During chemotherapy, liver atrophy and irregular liver surface appearance were confirmed with CT. Eventually, the disease progressed to death, and an autopsy was performed. The autopsy demonstrated exacerbation of diffuse liver metastases and cirrhosis-like findings.
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Affiliation(s)
- Sachiko Nakano
- Department of Nuclear Medicine, Cancer Institute Hospital, Koto, Tokyo, Japan.,Department of Diagnostic Radiology, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Tsukasa Suzuki
- Department of Pathology, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Yoshiaki Takase
- Department of Thoracic Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Masashi Ito
- Department of Respiratory Medicine, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Takashi Osaki
- Department of Respiratory Medicine, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Akihiro Yoshii
- Department of Respiratory Medicine, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Takashi Terauchi
- Department of Nuclear Medicine, Cancer Institute Hospital, Koto, Tokyo, Japan
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13
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Vernuccio F, Porrello G, Cannella R, Vernuccio L, Midiri M, Giannitrapani L, Soresi M, Brancatelli G. Benign and malignant mimickers of infiltrative hepatocellular carcinoma: tips and tricks for differential diagnosis on CT and MRI. Clin Imaging 2021; 70:33-45. [PMID: 33120287 DOI: 10.1016/j.clinimag.2020.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) may have an infiltrative appearance in about 8-20% of cases. Infiltrative HCC can be a challenging diagnosis and it is associated with the worst overall survival among HCC patients. Infiltrative HCC is characterized by the spread of multiple minute nodules throughout the liver, without a dominant one, ultimately resulting into macrovascular invasion. On CT and MRI, infiltrative HCC appears as an ill-defined, large mass, with variable degree of enhancement, and satellite neoplastic nodules in up to 52% of patients. On MRI, it may show restriction on diffusion weighted imaging, hyperintensity on T2- and hypointensity on T1-weighted images, and, if hepatobiliary agent is used, hypointensity on hepatobiliary phase. Infiltrative HCC must be differentiated from other liver diseases, such as focal confluent fibrosis, steatosis, amyloidosis, vascular disorders of the liver, cholangiocarcinoma, and diffuse metastatic disease. In cirrhotic patients, the identification of vascular tumor invasion of the portal vein and its differentiation from bland thrombosis is of utmost importance for patient management. On contrast enhanced CT and MRI, portal vein tumor thrombosis appears as an enhancing thrombus within the portal vein, close to the main tumor and results into vein enlargement. The aim of this pictorial review is to show CT and MRI features that allow the diagnosis of infiltrative HCC and portal vein tumor thrombosis. A particular point of interest includes the tips and tricks for differential diagnosis with potential mimickers of infiltrative HCC.
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Affiliation(s)
- Federica Vernuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; University Paris Diderot, Sorbonne Paris Cité, Paris, France; I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124 Messina, Italy; Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy.
| | - Giorgia Porrello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Roberto Cannella
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Laura Vernuccio
- U.O.C. Geriatria e Lungodegenza, AOUP University Hospital Palermo, CDCD Geriatria, Palermo, Italy
| | - Massimo Midiri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Lydia Giannitrapani
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Maurizio Soresi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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14
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Borisovsky G, Goldstein DA, Eliakim-Raz N, Tamir SR. Transitional Cell Carcinoma and Pseudocirrhosis— A Case Report and Review of the Literature. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1713829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractPseudocirrhosis is the occurrence of capsular retraction in patients with metastatic liver disease, usually of breast origin. It usually appears in these patients following chemotherapy and may result from shrinkage of the tumor, with scarring and nodular regeneration. In this article, we describe the first case of pseudocirrhosis, following treatment of transitional cell carcinoma metastatic to the liver. Portal vein thrombosis, a rare complication in pseudocirrhosis, was also detected in this patient.
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Affiliation(s)
- Gilad Borisovsky
- Radiology Department, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel A. Goldstein
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Eliakim-Raz
- Internal Medicine E, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit R. Tamir
- Radiology Department, Rabin Medical Center, Petah Tikva, Israel, affliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Adler M, Tang I, Gach MW, MacFaul G. Recurrent metastatic breast cancer presenting with portal hypertension and pseudocirrhosis. BMJ Case Rep 2019; 12:12/11/e231044. [PMID: 31767605 DOI: 10.1136/bcr-2019-231044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We present a case of a 63-year-old woman with an acute history of abdominal distension and shortness of breath. She had no risk factors for liver disease though her prior medical history was positive for breast carcinoma, in remission for 14 years. Examination and investigations were initially consistent with decompensated cirrhosis, thought to be due to subclinical autoimmune hepatitis. Imaging revealed hepatic contour irregularity, atrophy of the liver parenchyma and numerous lesions highly suggestive for multifocal hepatocellular carcinoma. Surprisingly, tissue histology revealed no evidence of cirrhosis, but recurrence of breast cancer which had mimicked cirrhosis. Pseudocirrhosis may be indistinguishable from true cirrhosis without histopathology. It has previously been linked to chemotherapy-induced hepatic injury and nodular regenerative hyperplasia, although our case illustrates an uncommon pathophysiology. Pseudocirrhosis often represents a poor prognosis even with a good baseline performance status, and early involvement of palliative care specialists may be advisable.
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Affiliation(s)
- Maciej Adler
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Ivan Tang
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Michael William Gach
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - George MacFaul
- Department of Gastroenterology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
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16
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Oliai C, Douek ML, Rhoane C, Bhutada A, Ge PS, Runyon BA, Wang X, Hurvitz SA. Clinical features of pseudocirrhosis in metastatic breast cancer. Breast Cancer Res Treat 2019; 177:409-417. [PMID: 31175499 PMCID: PMC6664810 DOI: 10.1007/s10549-019-05311-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Pseudocirrhosis has been demonstrated to mimic cirrhosis radiographically, but studies evaluating the pathophysiology and clinical features are lacking. To better understand the incidence, risk factors, clinical course, and etiology of pseudocirrhosis, we performed a retrospective analysis of consecutively treated patients with metastatic breast cancer (MBC). METHODS Of 374 patients treated for MBC from 2006 to 2012, 199 had imaging available for review. One radiologist evaluated computed tomography scans for evidence of pseudocirrhosis. Features of groups with and without pseudocirrhosis were compared by Kaplan-Meier product-limit survival estimates and log-rank tests. Wilcoxon Rank-Sum testing evaluated if patients more heavily treated were more likely to develop pseudocirrhosis. Univariate and multivariate Cox proportional hazard models investigated factors associated with mortality. RESULTS Pseudocirrhosis developed in 37 of 199 patients (19%). Of the patients with liver metastases, 55% developed pseudocirrhosis. Liver metastases were demonstrated in 100% of patients with pseudocirrhosis. Survival in the subset with liver metastases favored those without pseudocirrhosis, 189 versus 69 months (p = 0.01). The number of systemic regimens received were higher in patients with pseudocirrhosis (p = 0.01). Ascites was demonstrated in 68%, portal hypertension in 11%, and splenomegaly in 8% of patients with pseudocirrhosis. CONCLUSIONS Pseudocirrhosis does not occur in the absence of liver metastases, can manifest as hepatic decompensation, and appears to be associated with poorer survival amongst patients with hepatic metastases. Higher cumulative exposure to systemic therapy may be causative, instead of the previously held belief of pseudocirrhosis as an adverse effect of a particular systemic agent/class.
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Affiliation(s)
- Caspian Oliai
- Department of Medicine, Division of Hematology-Oncology, University of California, Los Angeles, 10945 Le Conte Ave, PVUB Suite 3360, Los Angeles, CA, 90095, USA
| | - Michael L Douek
- Department of Radiology, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Caelainn Rhoane
- Department of Medicine, Division of Hematology-Oncology, University of California, Los Angeles, 10945 Le Conte Ave, PVUB Suite 3360, Los Angeles, CA, 90095, USA
| | - Abhishek Bhutada
- Department of Radiology, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77004, USA
| | - Bruce A Runyon
- Department of Gastroenterology & Hepatology, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Xiaoyan Wang
- Department of Biostatistics, UCLA, 911 Broxton Ave., 3rd Floor, Los Angeles, CA, 90095, USA
| | - Sara A Hurvitz
- Department of Medicine, Division of Hematology-Oncology, University of California, Los Angeles, 10945 Le Conte Ave, PVUB Suite 3360, Los Angeles, CA, 90095, USA.
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17
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Aoyagi T, Takabe K, Tamanuki T, Matsubara H, Matsuzaki H. Pseudocirrhosis after chemotherapy in breast cancer, case reports. Breast Cancer 2018; 25:614-618. [PMID: 29696562 DOI: 10.1007/s12282-018-0865-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/21/2018] [Indexed: 01/26/2023]
Abstract
Pseudocirrhosis is a rare hepatic complication of chemotherapy, which is morphological changes in hepatic contour that closely mimic cirrhosis. Like in classic cirrhosis, portal hypertension is common in patients with this condition. The mechanism of pseudocirrhosis is unknown to date. We report three cases of pseudocirrhosis arising in the setting of regression of breast cancer liver metastases. All the cases underwent systemic chemotherapy, and all had remarkable responses. Their hormone receptor statuses were all positive and Her2/neu statuses were all negative. They were all treated with cytotoxic chemotherapeutic agent and also hormone therapy. This report suggests clinicians should have pseudocirrhosis in mind when hormone therapy and cytotoxic chemotherapy are jointly administered.
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Affiliation(s)
- Tomoyoshi Aoyagi
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, 273-8588, Japan.
| | - Kazuaki Takabe
- Division of Breast Surgery, Department of Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, The State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Tamaki Tamanuki
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, 273-8588, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Matsuzaki
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, 273-8588, Japan
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18
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Hidalgo-Blanco A, Aguirresarobe-Gil de San Vicente M, Aresti S, de Miguel E, Cabriada-Nuno JL. Pseudocirrhosis in metastatic breast cancer. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:111-113. [PMID: 28187872 DOI: 10.1016/j.gastrohep.2016.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/18/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alba Hidalgo-Blanco
- Servicio de Aparato Digestivo, Hospital de Galdakao-Usansolo, Usansolo, Bizkaia, España.
| | | | - Santi Aresti
- Servicio de Aparato Digestivo, Hospital de Galdakao-Usansolo, Usansolo, Bizkaia, España
| | - Eduardo de Miguel
- Servicio de Anatomía Patológica, Hospital de Galdakao-Usansolo, Usansolo, Bizkaia, España
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19
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Ünal E, Akata D, Karcaaltincaba M. Liver Function Assessment by Magnetic Resonance Imaging. Semin Ultrasound CT MR 2016; 37:549-560. [DOI: 10.1053/j.sult.2016.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Kumamoto K, Endo S, Isohata N, Nirei A, Nemoto D, Utano K, Saito T, Togashi K. Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases. Mol Clin Oncol 2016; 6:63-66. [PMID: 28123730 DOI: 10.3892/mco.2016.1096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/18/2016] [Indexed: 01/13/2023] Open
Abstract
A 70-year-old man who was diagnosed with unresectable advanced rectal cancer with multiple liver metastases, received oxaliplatin-based treatment with bevacizumab as first-line chemotherapy and irinotecan-based treatment with bevacizumab as second-line chemotherapy for a total of 17 months. The patient was treated with regorafenib (160 mg/day for 3 weeks) as third-line chemotherapy. Following completion of one course of regorafenib treatment, the patient complained of abdominal distension. Computed tomography (CT) examination identified liver atrophy and massive ascites, while no such symptoms were observed prior to the regorafenib treatment. Blood testing revealed increases in the aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels. The patient was admitted to the Aizu Medical Center (Aizuwakamatsu, Japan). Approximately 2,000 ml of ascitic fluid were aspirated daily for 1 week by abdominal puncture. The patient was administered oral diuretics, including 20 mg/day of furosemide and 25 mg/day of spironolactone. Albumin was administered to correct the albumin deficit. The levels of AST, ALT and ALP were decreased from the peak value reported on admission and the patient was discharged from our hospital 16 days following treatment initiation. The CT examination after 1 month revealed that the volume of the liver had been restored and the ascites had disappeared. Furthermore, almost all the liver metastases were reduced in size. The carcinoembryonic antigen level, which was elevated prior to regorafenib treatment, also decreased to normal.
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Affiliation(s)
- Kensuke Kumamoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Azuma Nirei
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Takuro Saito
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima 969-3492, Japan
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21
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Karaosmanoglu AD, Onur MR, Ozmen MN, Akata D, Karcaaltincaba M. Magnetic Resonance Imaging of Liver Metastasis. Semin Ultrasound CT MR 2016; 37:533-548. [PMID: 27986172 DOI: 10.1053/j.sult.2016.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver magnetic resonance imaging (MRI) is becoming the gold standard in liver metastasis detection and treatment response assessment. The most sensitive magnetic resonance sequences are diffusion-weighted images and hepatobiliary phase images after Gd-EOB-DTPA. Peripheral ring enhancement, diffusion restriction, and hypointensity on hepatobiliary phase images are hallmarks of liver metastases. In patients with normal ultrasonography, computed tomography (CT), and positron emission tomography (PET)-CT findings and high clinical suspicion of metastasis, MRI should be performed for diagnosis of unseen metastasis. In melanoma, colon cancer, and neuroendocrine tumor metastases, MRI allows confident diagnosis of treatment-related changes in liver and enables differential diagnosis from primary liver tumors. Focal nodular hyperplasia-like nodules in patients who received platinum-based chemotherapy, hypersteatosis, and focal fat can mimic metastasis. In cancer patients with fatty liver, MRI should be preferred to CT. Although the first-line imaging for metastases is CT, MRI can be used as a problem-solving method. MRI may be used as the first-line method in patients who would undergo curative surgery or metastatectomy. Current limitation of MRI is low sensitivity for metastasis smaller than 3mm. MRI fingerprinting, glucoCEST MRI, and PET-MRI may allow simpler and more sensitive diagnosis of liver metastasis.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Akata
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Musturay Karcaaltincaba
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
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22
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Adike A, Karlin N, Menias C, Carey EJ. Pseudocirrhosis: A Case Series and Literature Review. Case Rep Gastroenterol 2016; 10:381-391. [PMID: 27721722 PMCID: PMC5043255 DOI: 10.1159/000448066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/28/2016] [Indexed: 12/28/2022] Open
Abstract
Pseudocirrhosis describes morphological changes of the liver that closely mimic cirrhosis, without the typical histopathological changes seen in cirrhosis. It most commonly occurs in patients with metastatic breast cancer, although it has been reported in other malignancies as well. Like in cirrhosis, portal hypertension is often seen in patients with pseudocirrhosis. Pseudocirrhosis is a rare but important complication of metastatic cancer. In this case series and literature review, we describe 6 patients with hormone-receptor-positive metastatic breast cancer. We report the significant morbidity associated with pseudocirrhosis in the course of treatment in patients with metastatic breast cancer.
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Affiliation(s)
- Abimbola Adike
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Nina Karlin
- Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Christine Menias
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Elizabeth J Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Ariz., USA
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23
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Mitani S, Kadowaki S, Taniguchi H, Muto H, Muro K. Pseudocirrhosis in Gastric Cancer with Diffuse Liver Metastases after a Dramatic Response to Chemotherapy. Case Rep Oncol 2016; 9:106-11. [PMID: 27293396 PMCID: PMC4899638 DOI: 10.1159/000443876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We present the first reported case of pseudocirrhosis arising after a dramatic response to chemotherapy in metastatic gastric cancer. A 74-year-old man was diagnosed with gastric adenocarcinoma having multiple liver metastases. His general condition was poor, with an Eastern Cooperative Oncology Group performance status of 3, inadequate oral intake, and jaundice (total bilirubin 2.8 mg/dl). Chemotherapy with oxaliplatin, l-leucovorin, and 5-fluorouracil (modified FOLFOX-6) was initiated. After four treatment cycles, he experienced a marked regression of liver metastases; however, he developed massive ascites with a lobular liver surface and segmental atrophy, which were consistent with pseudocirrhosis. Chemotherapy was continued along with ascites management. Thereafter, ascites disappeared, and a complete response of the metastatic lesions was achieved at 11 months after initial treatment. He had no evidence of disease progression at 30 months after initial chemotherapy. This report suggests clinicians should recognize this entity, even in gastric cancer metastatic to the liver.
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Affiliation(s)
- Seiichiro Mitani
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shigenori Kadowaki
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroya Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hisanori Muto
- Department of Gastroenterology, Kainan Hospital, Yatomi, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Imaging of Fluid in Cancer Patients Treated With Systemic Therapy: Chemotherapy, Molecular Targeted Therapy, and Hematopoietic Stem Cell Transplantation. AJR Am J Roentgenol 2015; 205:709-19. [DOI: 10.2214/ajr.15.14459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Sharma A, Houshyar R, Bhosale P, Choi JI, Gulati R, Lall C. Chemotherapy induced liver abnormalities: an imaging perspective. Clin Mol Hepatol 2015; 20:317-26. [PMID: 25320738 PMCID: PMC4197183 DOI: 10.3350/cmh.2014.20.3.317] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.
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Affiliation(s)
- Ankush Sharma
- Department of Internal Medicine, University of California, Irvine, Orange, CA, USA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California, Irvine, Orange, CA, USA
| | - Priya Bhosale
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joon-Il Choi
- Department of Radiology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Rajesh Gulati
- Department of Internal Medicine, University of California, Irvine, Orange, CA, USA
| | - Chandana Lall
- Department of Radiological Sciences, University of California, Irvine, Orange, CA, USA
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Jeong WK, Choi SY, Kim J. Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer. Clin Mol Hepatol 2014; 19:190-4. [PMID: 23837145 PMCID: PMC3701853 DOI: 10.3350/cmh.2013.19.2.190] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University Schoold of Medicine, Seoul, Korea.
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Lee SL, Chang ED, Na SJ, Kim JS, An HJ, Ko YH, Won HS. Pseudocirrhosis of breast cancer metastases to the liver treated by chemotherapy. Cancer Res Treat 2014; 46:98-103. [PMID: 24520229 PMCID: PMC3918533 DOI: 10.4143/crt.2014.46.1.98] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/06/2013] [Indexed: 12/28/2022] Open
Abstract
Pseudocirrhosis refers to a condition that shows changes in hepatic contour that mimic cirrhosis radiographically in the absence of the typical histopathological findings of cirrhosis. This condition has been observed in patients with cancer metastatic to the liver, both in those who have undergone prior systemic chemotherapy and those who have not. Pseudocirrhosis may cause difficulty in interpretation of the response to chemotherapy and hepatic decompression and complication of portal hypertension have a negative effect on the prognosis. We report on a case of breast cancer with liver metastases that showed cirrhotic changes during disease progression. Progression of liver metastases was confirmed by F18 fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT). We also performed ultrasound-guided liver biopsy and confirmed tumor infiltration with severe desmoplastic fibrosis. This case suggests the pathogenesis of pseudocirrhosis through histopathological findings and the role of PET-CT in evaluation of the response to chemotherapy in patients with pseudocirrhosis.
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Affiliation(s)
- Su Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Eun Deok Chang
- Department of Hospital Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Sae Jung Na
- Department of Nuclear Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Jeong Soo Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Ho Jung An
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Hye Sung Won
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
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Harry BL, Smith ML, Burton JR, Dasari A, Eckhardt SG, Diamond JR. Medullary thyroid cancer and pseudocirrhosis: case report and literature review. ACTA ACUST UNITED AC 2013; 19:e36-41. [PMID: 22328846 DOI: 10.3747/co.19.840] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pseudocirrhosis is a rare form of liver disease that can cause clinical symptoms and radiographic signs of cirrhosis; however, its histologic features suggest a distinct pathologic process. In the setting of cancer, hepatic metastases and systemic chemotherapy are suspected causes of pseudocirrhosis. Here, we present a patient with medullary thyroid carcinoma metastatic to the liver who developed pseudocirrhosis while on maintenance sunitinib after receiving 5-fluorouracil, leucovorin, and oxaliplatin (folfox) in combination with sunitinib. Cirrhotic change in liver morphology was accompanied by diffusely infiltrative carcinomatous disease resembling the primary tumor. We discuss the diagnosis of pseudocirrhosis in this case and review the literature regarding pseudocirrhosis in cancer.
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Affiliation(s)
- B L Harry
- Medical Scientist Training Program, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, U.S.A
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Liu YI, Jha P, Wang ZJ, Yeh BM, Poder L, Westphalen AC, Coakley FV. Abdominal complications of chemotherapy: findings at computed tomography. Clin Imaging 2012; 36:54-60. [DOI: 10.1016/j.clinimag.2011.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/11/2011] [Indexed: 12/28/2022]
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Spectrum of Medication-Induced Complications in the Abdomen: Role of Cross-Sectional Imaging. AJR Am J Roentgenol 2011; 197:W286-94. [DOI: 10.2214/ajr.10.5415] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
OBJECTIVE The objective of this article is to provide a practical review of the conditions other than cirrhosis that can result in diffuse surface nodularity of the liver or portal hypertension. CONCLUSION Conditions that can mimic cirrhosis on imaging include pseudocirrhosis of treated breast cancer metastases to the liver, fulminant hepatic failure, miliary metastases, sarcoidosis, schistosomiasis, congenital hepatic fibrosis, idiopathic portal hypertension, early primary biliary cirrhosis, chronic Budd-Chiari syndrome, chronic portal vein thrombosis, and nodular regenerative hyperplasia.
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Vilgrain V. La rétraction capsulaire hépatique : un signe utile à reconnaître. ACTA ACUST UNITED AC 2009; 90:1019-20. [DOI: 10.1016/s0221-0363(09)73239-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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