Pseudocirrhosis

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

Known right breast cancer subjected to mastectomy, presented with recurrence of the right axillary lymph nodes for metastatic workup

Patient Data

Age: 55 years
Gender: Female
CT

Baseline study

The liver is normal in size and density with a non-enhanced focal lesion in segment VI
in the liver to small to characterize however a possibility of metastasis cannot be
ruled out. A tiny calcific focus is noted in segment 4 A probably consistent with old
granuloma.

Peri-pelvic cysts are seen.  

CT

After about 33 months from above study.

The above CT study was reviewed and compared.
Liver shows newly developed multiple innumerable hypodense focal lesions of
variable sizes in both right and left lobes likely metastatic deposits, largest is seen in segment VIII close to the hepatic dome. No IHBR dilatation.
Few newly seen sub-centimetric lymph nodes seen in the left gastric region.
Stable previously seen hemangioma in L3 vertebra. No suspicious bony lesions.

the rest visualized organs are unremarkable. 
Impression:
Newly developed multiple hepatic and pulmonary ( not provided ) metastases.

CT

After about 11 months from last study.

The above CT studies were reviewed and compared.

As noted earlier evidence of right mastectomy.

The liver shows diffusely nodular outline with pronounced areas of capsular retraction and diffuse nodular hepatic surface suggestive of pseudocirrhosis, however, noted multiple innumerable hypodense tiny focal lesions in both lobes. No IHBR dilatation.

Newly seen partial thrombosis seen within the main portal vein.prominent venous collaterals are seen at the lienorenal region.

Newly developed moderate abdominal ascites with mesenteric vascular congestion and tiny nodular mesenteric fatty standings are seen.

The gallbladder contains is contracted on dense calculi within.

Case Discussion

A known case of metastatic breast cancer on chemotherapy with no history of liver disease showing;

  • Pretreatment abdominal CT show liver with normal morphology with the small hypodense liver lesion.
  • A follow-up study showing after 33 months show newly developed multiple innumerable hypodense focal lesions of variable sizes in both lobes likely metastatic deposits and after that, the patient starting chemotherapy.
  • After 11 months from starting chemotherapy showing; a progressive course in the liver, as shrunken the liver and discrete lobulation and nodular the hepatic surface.

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 characterized 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, the 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: 54261
Case created: 30th Jun 2017
Last edited: 8th Jul 2017
Inclusion in quiz mode: Included

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