Recurrent metastatic breast cancer presenting with portal hypertension and pseudocirrhosis

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.

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

“…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 ].…”

Liver metastases - An unusual cause of portal hypertension: A case report

“…In patients with liver metastases, chemotherapy can result in areas of retracted tumor tissue and scarring, also known as pseudocirrhosis (resembling cirrhosis radiographically but lacking pathologic features), which can also lead to hepatic decompensation [ 2 ]. Pseudocirrhosis is mainly associated with the progression of malignancy receiving chemotherapy [ 10 ]. Several agents are associated with pseudocirrhosis in patients with breast cancer, like adriamycin, cyclophosphamide, 5-fluorouracil, methotrexate, cisplatin, tamoxifen, paclitaxel, vinblastine, etoposide, and vincristine [ 4 , 11 ].…”

“…This case illustrates an atypical presentation with symptoms consistent with portal hypertension and chronic liver disease without prior exposure to chemotherapy. This could be due to the tumor deposits resulting in sinusoidal obstruction, subsequently leading to portal hypertension [ 10 ]. This is the first reported case of pseudocirrhosis due to liver metastasis from breast carcinoma in Nepal.…”

Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center

“…Pseudocirrhosis has been described most frequently in patients with liver metastases from breast cancer (12)(13)(14)(15)(16)(17)(18)(19). The underlying pathophysiology is largely unknown, but the proposed hypotheses include: (1) regenerative hyperplasia secondary to ischemic or free-radical induced hepatocyte injury in response to systemic therapies, (2) exaggerated desmoplastic response to liver metastases, (3) scarring and capsular retraction resulting from response of liver metastases to therapy, and (4) sinusoidal occlusion caused by chemotherapy-related injury (17,18,20).…”