Pseudocirrhosis

Changed by Mohammad Taghi Niknejad, 4 Jan 2024
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Disclosures - updated 29 Dec 2023: Nothing to disclose

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Pseudocirrhosis is a radiological term used to convey the imaging findings of cirrhosis, but emphasiseemphasises that it occurs in the setting of hepatic metastases. It is most commonly reported following chemotherapeutic treatment of breast cancer metastases, although it has also been reported before treatment, and with other malignancies, including pancreatic cancer, colon cancer, medullary thyroid cancer and oesophageal cancer 5.

Terminology

The term "pseudocirrhosis" is intended to convey a different disease process compared with cirrhosis of chronic liver disease.

Clinical presentation

Although most cases are mainly identified on an imaging basis, particularly found on post-treatment surveillance scans, patients may have symptoms related to liver failure and and portal hypertension, including abdominal distension due to ascites.

Pathology

Two pathophysiologic correlates of pseudocirrhosis have been described 4:

  • hepatic capsular retraction in response to chemotherapeutic agents, with nodular regenerative hyperplasia and absence of bridging fibrosis or cirrhosis on histopathology

  • extensive fibrosis representing a profound desmoplastic response to an infiltrating tumour, occurring prior to chemotherapy

Radiographic features

Imaging manifestations on CT, ultrasound, and MRI may be identical to liver cirrhosis, and consist of:

  • -<p><strong>Pseudocirrhosis</strong> is a radiological term used to convey the imaging findings of <a href="/articles/cirrhosis">cirrhosis</a>, but emphasise that it occurs in the setting of <a href="/articles/hepatic-metastases-1">hepatic metastases</a>. It is most commonly reported following chemotherapeutic treatment of breast cancer metastases, although has also been reported before treatment, and with other malignancies <sup>5</sup>.</p><h4>Terminology</h4><p>The term "pseudocirrhosis" is intended to convey a different disease process compared with cirrhosis of chronic liver disease.</p><h4>Clinical presentation</h4><p>Although most cases are mainly identified on an imaging basis, particularly found on post-treatment surveillance scans, patients may have symptoms related to <a href="/articles/acute-liver-failure">liver failure</a> and <a href="/articles/portal-hypertension">portal hypertension</a>, including abdominal distension due to <a href="/articles/ascites">ascites</a>. </p><h4>Pathology</h4><p>Two pathophysiologic correlates of pseudocirrhosis have been described <sup>4</sup>:</p><ul>
  • -<li>hepatic capsular retraction in response to chemotherapeutic agents, with nodular regenerative hyperplasia and absence of bridging fibrosis or cirrhosis on histopathology</li>
  • -<li>extensive fibrosis representing a profound desmoplastic response to an infiltrating tumour, occurring prior to chemotherapy</li>
  • -</ul><h4>Radiographic features</h4><p>Imaging manifestations on CT, ultrasound, and MRI may be identical to liver cirrhosis, and consist of:</p><ul>
  • -<li>variable <a href="/articles/hepatic-capsular-retraction">capsular retraction</a> and liver nodularity</li>
  • -<li>hepatic segmental volume loss</li>
  • -<li><a href="/articles/hypertrophy-of-the-caudate-lobe">caudate lobe enlargement​</a></li>
  • -<li>nodular contour</li>
  • -<li>confluent fibrosis</li>
  • +<p><strong>Pseudocirrhosis</strong> is a radiological term used to convey the imaging findings of <a href="/articles/cirrhosis">cirrhosis</a> but emphasises that it occurs in the setting of <a href="/articles/hepatic-metastases-1">hepatic metastases</a>. It is most commonly reported following chemotherapeutic treatment of <a href="/articles/breast-cancer-metastases-1" title="Breast cancer metastases">breast cancer metastases</a>, although it has also been reported before treatment and with other malignancies, including <a href="/articles/pancreatic-ductal-adenocarcinoma-4" title="Pancreatic cancer">pancreatic cancer</a>, <a href="/articles/colorectal-cancer-1" title="Colon cancer">colon cancer</a>, <a href="/articles/medullary-thyroid-carcinoma-1" title="Medullary thyroid cancer">medullary thyroid cancer</a> and <a href="/articles/oesophageal-carcinoma-1" title="Oesophageal cancer">oesophageal cancer</a> <sup>5</sup>.</p><h4>Terminology</h4><p>The term "pseudocirrhosis" is intended to convey a different disease process compared with cirrhosis of chronic liver disease.</p><h4>Clinical presentation</h4><p>Although most cases are mainly identified on an imaging basis, particularly found on post-treatment surveillance scans, patients may have symptoms related to <a href="/articles/acute-liver-failure">liver failure</a>&nbsp;and <a href="/articles/portal-hypertension">portal hypertension</a>, including abdominal distension due to <a href="/articles/ascites">ascites</a>.&nbsp;</p><h4>Pathology</h4><p>Two pathophysiologic correlates of pseudocirrhosis have been described <sup>4</sup>:</p><ul>
  • +<li><p>hepatic capsular retraction in response to chemotherapeutic agents, with nodular regenerative hyperplasia and absence of bridging fibrosis or cirrhosis on histopathology</p></li>
  • +<li><p>extensive fibrosis representing a profound desmoplastic response to an infiltrating tumour, occurring prior to chemotherapy</p></li>
  • +</ul><h4>Radiographic features</h4><p>Imaging manifestations on CT, ultrasound, and MRI may be identical to liver cirrhosis, and consist of:</p><ul>
  • +<li><p>variable <a href="/articles/hepatic-capsular-retraction">capsular retraction</a> and liver nodularity</p></li>
  • +<li><p>hepatic segmental volume loss</p></li>
  • +<li><p><a href="/articles/hypertrophy-of-the-caudate-lobe">caudate lobe enlargement​</a></p></li>
  • +<li><p>nodular contour</p></li>
  • +<li><p>confluent fibrosis</p></li>
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Image 11 CT (C+ portal venous phase) ( create )

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