A case of cryptogenic pseudocirrhosis causing acute liver failure: when clinic and radiology work together

Abstract

It is known that a wild spectrum of hepatic manifestations can be common presentations of metastatic breast cancer. Pseudocirrhosis pattern has been often described as almost always secondary to systemic chemotherapy and it is defined by morphological liver changes that mimic cirrhosis including capsular retraction, nodularity, parenchyma atrophy and caudate lobe, radiologically identifiable. Acute liver injury is an occasional complication in oncologic patients, and it outlines an organ failure when there is evidence of encephalopathy and coagulopathy (international normalized ratio >1.5) in the absence of pre-existing liver disease, with an illness of <26 weeks duration. The two most common etiologies are leukemia/lymphoma followed by breast cancer but also in this case, liver is involved almost always after chemotherapy, hormonotherapy or radiotherapy. Here we present a case of rapid evolving acute liver failure presented as cryptogenic pseudocirrhosis without any evidence of primitive breast cancer but an incidental demonstration.

Pseudocirrhosis and portal hypertension in patients with metastatic cancers: a systematic review and meta-analysis

“… Yes Eidenschink et al 41 US 1 Breast 83 F Breast cancer cells n.a. 7.9 2.6 No Finocchi et al 42 Italy 1 Breast 46 F Breast cancer cells; fibrosis n.a. 3.3 2.6 No Fournier et al 43 US 1 Breast 52 F Breast cancer cells 50.000 17 n.a.…”