Pseudocirrhosis in a Patient with New-Onset Dysphagia and History of Ovarian Carcinoma

Zanazanian, Andrew; Kalani, Amir; Tabibian, James H.

doi:10.14309/crj.2018.29

Cited by 6 publications

(4 citation statements)

References 6 publications

(13 reference statements)

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“…Pseudocirrhosis is a radiologic diagnosis that describes morphologic changes of the liver mimicking cirrhosis that arise in the setting of metastatic malignancy. Most cases in the published literature are found in metastatic breast cancer [ 1 , 4 , 6 , 26 , 54 ], but cases have been reported in other primary malignancies, including pancreatic [ 43 ], colorectal [ 44 , 45 ], gastric [ 46 – 48 ], esophageal [ 49 ], lung [ 50 , 51 ], ovarian [ 52 ], and medullary thyroid cancers [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pseudocirrhosis has been most frequently described in the setting of metastatic breast cancer [ 38 – 42 ]. Apart from breast cancer, cases have been reported in primary malignancies, such as pancreatic [ 43 ], colorectal [ 44 , 45 ], gastric [ 46 – 48 ], esophageal [ 49 ], lung [ 50 , 51 ], ovarian [ 52 ], and medullary thyroid cancers [ 53 ].…”

Section: Introductionmentioning

confidence: 99%

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Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

Sadlik,

Anderson,

Lei

et al. 2024

Dig Dis Sci

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

Sadlik,

Anderson,

Lei

et al. 2024

Dig Dis Sci

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“…However, this under-recognized and under-reported entity is typified by a distinctly more rapid clinical course as well as the absence of bridging fibrosis between regenerating nodules on histological examination (1,5). Though pseudocirrhosis was initially described almost exclusively in patients with breast cancer and liver metastases in the setting of systemic therapies, isolated cases have subsequently been reported in non-metastatic breast as well as colorectal, esophageal, pancreatic, ovarian, and thyroid cancers (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center

et al. 2021

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BackgroundPseudocirrhosis is characterized by radiological changes in the liver that resemble cirrhosis, but with more rapid onset and progression. Though reported most frequently in patients with metastatic breast cancer, little is known about its prognostic factors and impact on breast cancer outcomes.MethodsIn this observational study, we reviewed abdominal CT and/or MRI scan reports of all patients with invasive breast cancer diagnosed at our center, during a ten-year period, to identify patients with pseudocirrhosis. Exclusion criteria included lack of baseline imaging, pre-existing cirrhosis, hepatitis B or C, other chronic liver diseases, or heavy alcohol use. Routine descriptive statistical measures were used. Survival distributions were estimated using Kaplan-Meier method, and Cox regression was used for multivariate analysis. Two-tailed p < 0.05 was considered significant.ResultsEighty-six patients were included – all were females, median age was 57.5 years, and 90% were Caucasian; 86% of primary tumors were hormone-receptor positive and 17% were HER2 positive. Most patients (98%) had metastatic disease with liver involvement (94%), and were heavily pre-treated – 97% with chemotherapy, 85% with hormonal therapy, and 19% with anti-HER2 agents. Median interval from breast cancer diagnosis to pseudocirrhosis was 75.4 months (IQR 35.2-115.3 months). Thirty-six percentage of patients had ≥1 signs of portal hypertension and 49% had ≥1 signs of hepatocellular failure. Pseudocirrhosis led to permanent discontinuation of chemotherapy, endocrine therapy, and all systemic therapies in 29%, 31%, and 20% patients, respectively. Median overall survival from diagnosis of pseudocirrhosis was 10.0 months (95%CI 5.2-14.8 months). On multivariate analysis, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and cancer progression were independently predictive of mortality.ConclusionsIn this largest series, to date, of breast cancer with pseudocirrhosis, the latter was often complicated by portal hypertension and hepatocellular failure, and markedly impacted breast cancer management. Survival was shorter for patients who developed hepatocellular failure.

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“…Characteristic features include lobular hepatic contour, segmental volume loss, and caudate lobe enlargement [6]. Although pseudocirrhosis is most often associated with breast cancer, it has also been reported in malignancies of the gastrointestinal (GI) tract, medullary thyroid, and ovary [7][8][9][10][11][12]. Most published studies are individual case reports, and larger case series are scarce [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Metastatic Breast Cancer in Patients Having Both Pseudocirrhosis and Portal Hypertension with Evident Varices

Ma¹,

Chang²,

Lin³

et al. 2021

Preprint

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Background: Pseudocirrhosis is an imaging finding of malignancies with liver metastasis with or without clinical liver cirrhosis–related complications such as portal hypertension (pHTN). This study compared the outcomes of metastatic breast cancer in patients with imaging-diagnosed pseudocirrhosis with or without pHTN. Methods: The medical records from patients with metastatic breast cancer and pseudocirrhosis between 2005 and 2017 were retrospectively analyzed. Clinical pHTN was defined 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. In total, 81 (76%) had initial metastases in both hepatic lobes, 91 (86%) had 4 or more liver metastases, and 32 (30%) had pHTN. The median overall survival (OS) was 5 and 13 months in patients with and without pHTN, respectively (p = .002). The median OS in patients with HER2-positive, HR-positive/HER2-negative, and triple-negative breast cancer was 16, 9, and 2 months, respectively (p = .001). Patients with pHTN generally had cirrhotic complications, including gastrointestinal bleeding, hyperbilirubinemia, hyperammonemia, and coagulopathy. Despite their challenging clinical conditions, 7 patients with pHTN had OS exceeding 1 year. In multivariate analysis, pHTN (p = .007) and triple-negative breast cancer (p = .013) were associated with poor OS. Conclusions: For patients with pseudocirrhosis, clinical pHTN was associated with liver cirrhosis–related complications and shorter median OS. A few patients with pHTN had prolonged OS with effective systemic treatment and aggressive supportive care.

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Pseudocirrhosis in a Patient with New-Onset Dysphagia and History of Ovarian Carcinoma

Cited by 6 publications

References 6 publications

Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center

Clinical Outcomes of Metastatic Breast Cancer in Patients Having Both Pseudocirrhosis and Portal Hypertension with Evident Varices

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