Pseudocirrhosis of Breast Cancer Metastases to the Liver Treated by Chemotherapy

Lee, Su Lim; Chang, Eun Deok; Na, Sae Jung; Kim, Jeong Soo; An, Ho Jung; Ko, Yoon Ho; Won, Hye Sung

doi:10.4143/crt.2014.46.1.98

Cited by 33 publications

(39 citation statements)

References 12 publications

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“…Although there were no data confirming that the patient had the UGT1A9 polymorphism, it was hypothesized that these genetic polymorphisms confer a clinical benefit but induce severe toxicity in the patient. Similar changes on imaging were previously reported in breast cancer with multiple liver metastases (10,11) and other cancers with multiple liver metastases, including pancreatic (12), esophageal (13) and thyroid cancer (14). The morphological changes of the liver in these cases are referred to as 'pseudocirrhosis'.…”

Section: Discussionsupporting

confidence: 56%

“…Although the precise mechanism underlying the development of pseudocirrhosis remains unknown, the response to systemic chemotherapeutic agents may induce cirrhotic changes with tumor shrinkage following chemotherapy. Previous reports (10)(11)(12) have indicated that pseudocirrhosis may be associated with nodular regenerative hyperplasia (NRH) caused by chemotherapy-induced hepatic injury. NRH is characterized by widespread transformation of nor mal liver parenchyma into hyperplastic regenerative nodules without bridging fibrosis, a characteristic that distinguishes this entity from liver cirrhosis (15).…”

Section: Discussionmentioning

confidence: 99%

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Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases

Kumamoto

Endo

Isohata

et al. 2016

Molecular and Clinical Oncology

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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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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases

Kumamoto

Endo

Isohata

et al. 2016

Molecular and Clinical Oncology

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“…Thus, suspected development of pseudocirrhosis at imaging in patients receiving chemotherapy must be communicated to the oncologist. While pseudocirrhosis typically occurs in the setting of positive treatment response, it can also occur with disease progression owing to infiltrating tumor, which can cause desmoplastic changes (52). MR imaging may help differentiate tumor response from progression, as the liver can become progressively heterogeneous with pseudocirrhosis at CT, limiting evaluation of disease burden.…”

Section: Hepatic Adverse Eventsmentioning

confidence: 99%

Unintended Consequences of Systemic and Ablative Oncologic Therapy in the Abdomen and Pelvis

et al. 2018

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Human cancers are genetically complex and diverse. Although advances in oncologic therapy aim to define and target unique steps in carcinogenesis, oncologists often rely on less discriminate anticancer therapies that have consequences for normal tissues. Even many of the so-called targeted therapies currently employed can adversely affect normal cells, leading to complications that necessitate dose reductions or cessation of specific therapies. This article explores the unintended consequences of currently employed systemic and ablative anticancer therapies that might manifest at imaging examinations of the abdomen and pelvis, including cytotoxic, molecular targeted, and immunologic agents; ablation; and hematopoietic stem cell transplant. Each of these treatments can have both major and minor unintended effects in the targeted organ(s), in local or adjacent structures, or at distant sites. Timely detection and reporting of adverse consequences of anticancer therapies by the astute imager can result in critical treatment modifications and/or lifesaving interventions; therefore, knowledge of these unintended effects is paramount for radiologists interpreting the results of imaging examinations in cancer patients. RSNA, 2018.

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“…Despite its radiographic similarity to cirrhosis, pseudocirrhosis does not have histologic findings of regenerative nodules and bridging fibrosis, which are defining changes of true cirrhosis. The complications of cirrhosis, such as portal hypertension and ascites, are less common in pseudocirrhosis but do occur (31).…”

Section: Livermentioning

confidence: 99%

Delineating Extramammary Findings at Breast MR Imaging

Gao¹,

Ibidapo²,

Toth³

et al. 2017

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Breast magnetic resonance (MR) imaging is the only breast imaging modality that consistently encompasses extramammary structures in the thorax and upper abdomen. Incidental extramammary findings on breast MR images of patients with a history of breast cancer or other malignancies are significantly more likely to be malignant and may affect staging and treatment. An understanding of the frequency, distribution, and context of extramammary findings on breast MR images and a familiarity with common and uncommon sites of breast cancer metastasis inform the differential diagnosis and prompt the appropriate diagnostic next step, to differentiate benign from malignant findings. High-yield organ systems on breast MR images, as reflected by a high positive predictive value for malignancy, are correlated with known distant sites of breast cancer metastasis in the bone, lung, liver, and lymph nodes. Staging is considered when disease involves the skin and chest wall. Unusual sites of breast cancer metastasis from invasive lobular carcinoma are discussed, including the gastrointestinal tract, peritoneum, and adrenal glands. Nonmalignant clinically important findings involving the cardiovascular and gastrointestinal systems are reviewed, and potential pitfalls in diagnosis and interpretation are highlighted. A consistently systematic diagnostic approach is emphasized for identifying extramammary abnormalities on breast MR images. All things considered, the radiologist should be able to improve diagnostic sensitivity and specificity while interpreting extramammary findings on breast MR images. RSNA, 2017.

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Pseudocirrhosis of Breast Cancer Metastases to the Liver Treated by Chemotherapy

Cited by 33 publications

References 12 publications

Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases

Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases

Unintended Consequences of Systemic and Ablative Oncologic Therapy in the Abdomen and Pelvis

Delineating Extramammary Findings at Breast MR Imaging

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