Breast cancer pseudocirrhosis

Case contributed by Dr Michael P Hartung

Presentation

History of breast cancer.

Patient Data

Age: 60
Gender: Female
CT

Presentation

Few small low-attenuation liver lesions. No other abnormalities. 

CT

1 year later

Diffusely abnormal liver with reticular and branching areas of low attenuation infiltrating throughout the parenchyma. Contour is lobulated. Size has enlarged from 1 year prior - notice how the right kidney is inferiorly displaced and deformed. 

Ascites. Right pleural effusion.

Splenomegaly. 

PATHOLOGY REPORT

Liver, Random: Biopsy: Metastatic poorly differentiated carcinoma, morphologically compatible with breast primary.

This case is compared with the patient's previous biopsy which showed invasive breast carcinoma and the morphology in the liver is identical, supporting the above interpretation.

Case Discussion

Pseudocirrhosis most often is used to describe the morphologic changes of cirrhosis developing in patients with metastatic breast cancer after chemotherapy. 

The pathophysiology of pseudocirrhosis can be due to scarring/capsular retraction following chemotherapy, desmoplastic reaction due to infiltrative metastases, and nodular regenerative hyperplasia.1

Thus, pseudocirrhosis can represent treatment response OR active metastases in the liver. 

In this case, the enlargement of the liver supports the pathologic diagnosis of active, infiltrative tumor throughout the liver. Notice how much the right kidney is inferiorly displaced on the follow-up exam due to hepatic enlargement.

The areas of reticular/branching fibrosis are likely related to a combination of fibrosis/desmoplastic reaction from the infiltrative tumor and liver injury from cholestasis and venous congestion. 

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Case information

rID: 65405
Published: 18th Jan 2019
Last edited: 18th Jan 2019
Inclusion in quiz mode: Included

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