Pseudocirrhosis: A Case Series and Literature Review

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.

Keywords: Metastatic breast cancer; Metastatic cancer; Portal hypertension; Pseudocirrhosis.

Fig. 1

Case 2: a 65-year-old woman with ER/PR(+) infiltrating ductal adenocarcinoma of the right breast. Contrast-enhanced axial CT images 2 years following mastectomy and adjuvant chemoradiation (a, b) show an enlarged fatty liver with several small hypodense round masses in both the right and left hepatic lobes corresponding to diffuse metastatic disease (white arrows in a, b).

Fig. 2

Case 2: follow-up contrast-enhanced CT in the same patient 6 months after initiation of paclitaxel and gemcitabine, followed by vinorelbine, ixabepilone and capecitabine showed features of pseudocirrhosis. Contrast-enhanced axial (a, b) and coronal (c) images show several ill-defined, somewhat linear, ‘band-like’ masses that extend to the periphery of the liver (yellow arrows in a–c). There is secondary capsular retraction and nodularity of the liver surface (red arrows in a, b) and an enlarged caudate lobe (black star in b). Changes of portal hypertension are present with paraesophageal varices (blue circle in a) and new ascites (green star in c).

Fig. 3

Upper endoscopy revealed type 1 gastric varices.

Fig. 4

a Fine needle aspiration biopsy of the liver normal parenchyma of the liver (right) with tumor infiltration with malignant cells (left). ×200. b, c Immunohistochemical staining of the liver tumor shows positive staining for Her2 3+ (×200) and positive staining for GATA-3 (×200). d Negative control for Her2 and GATA. ×100.

Fig. 5

Case 6: a 64-year-old woman with locally advanced ER/PR(–), HER 2(+) infiltrating, ductal carcinoma, treated with neoadjuvant chemotherapy with docetaxel, carboplatin and trastuzumab, subsequent mastectomy and adjuvant trastuzumab. Contrast-enhanced axial CT images show multiple small round hypodense masses in both the right and left hepatic lobes consistent with hepatic metastases (white arrows a, b).

Fig. 6

Case 6: follow-up contrast-enhanced CT 3 months after initiation of ado-trastuzumab emtansine showed features of pseudocirrhosis. Contrast-enhanced axial (a–c) CT images show interval atrophy of both the right and left hepatic lobes, with diffuse surface nodularity (red arrows in a, b). Ill-defined, linear, ‘band like’ masses that extend to the periphery of the liver (yellow arrows in a–c) correspond to bands of fibrosis. Changes of portal hypertension are present with splenomegaly, paraesophageal varices (blue circle in a) and new ascites (green star in b).