Hepatic pseudocirrhosis

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

A known case of breast cancer with metastasis to bone and liver on palliative chemotherapy for reevaluation.

Patient Data

Age: 50 years
Gender: Female
CT

The liver is normal in size with cirrhotic features, seen in the form of a fine nodular outline with multiple innumerable small hypodense focal lesions scattered in both lobes; features suggestive of pseudocirrhosis. No intrahepatic biliary dilatation. A non-complicated small gastric diverticulum is seen in the fundus of the stomach.

Visualised bone show innumerable osteolytic lesions are seen in the scanned bones and
stable dorso-lumbar fixation

CT

Follow up after 6 months

The appearances have markedly improved.

Case Discussion

A known case of metastatic breast cancer on palliative chemotherapy with the following features:

  • No history of liver disease. On pretreatment abdominal CT (not provided), the liver has a normal morphology and some hypodense liver metastasis within.
  • About 6 months after starting of chemotherapy, there is discrete lobulation of the hepatic surface.
  • After 6 months of adjusting chemotherapy, there is mild regressive course in liver pseudo-cirrhosis and less prominence of liver metastasis.

This case is a good example of an early pick up the pseudocirrhosis radiologically to avoid misdiagnosis of true liver cirrhosis.

Pseudocirrhosis is a radiologic term that describes the serial development of diffuse hepatic nodularity caused by chemotherapy for hepatic metastasis, especially from breast cancer.

It is characterised by morphologic changes mimicking liver cirrhosis, It is most common with breast cancer, but has also been reported to occur with other cancers, and is a potential cause of portal hypertension and hepatic failure. However, patients with pseudocirrhosis do not unusually show the clinical features of true liver cirrhosis.

Pseudocirrhosis is thought to be caused by two factors

  • hepatic irregularity/retraction from a decrease in the size of extensive metastatic disease in the liver
  • regenerative nodules, altering the liver surface
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Case information

rID: 54259
Case created: 30th Jun 2017
Last edited: 9th Jul 2017
Inclusion in quiz mode: Included

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