A Case of Pseudocirrhosis From Metastatic Breast Cancer

Abstract

Pseudocirrhosis, an uncommon important complication is seen in breast cancer patients post chemotherapy. It denotes radiological findings of diffuse hepatic macronodules mimicking liver cirrhosis with no histopathological changes of the latter. Case Report:A 63 year old woman with stage II breast cancer post six cycles of neoadjuvant chemotherapy, Herceptin therapy for one year, breast lumpectomy and radiotherapy in September 2011 presents for evaluation of jaundice. Blood chemistry revealed elevated AST 621 U/L ALT 251 U/L ALP 1367 U/L with normal total bilirubin 14.5 g/dL direct bilirubin 10.7 g/dL albumin 2.5 platelets 121.Abdominal US: innumerable hepatic lesions compatible with metastasis, 2.3 cm hypoechoic foci within the pancreatic body and thickening of the under distended gallbladder secondary to hepatocellular disease with no biliary ductal dilatation.CT chest: likely neoplastic left upper lobe mass with extensive mediastinal lymphadenopathy including the contralateral hilum and suspicion of neoplastic subcentimeter pulmonary nodule at the contralateral right lower lobe. CT abdomen and pelvis: Figure 1, innumerable hepatic metastasis with enlarged portohepatic LN suspicious for metastatic infiltration and an undetermined 1cm hypoenhancing lesion within the spleen. Liver biopsy: metastatic ductal carcinoma of the breast, +ve for GATA3, Her-2 receptor and weakly +ve estrogen receptor. FISH is in process to confirm diagnosis.2442 Figure 1 No Caption available.Discussion:Pseudocirrhosis is frequently documented in breast cancer patients with liver metastasis post chemotherapy. Although patients with pseudocirrhosis maybe asymptomatic, many present with the consequential complications of portal hypertension: abdominal distention and ascites being the most common2. In our patient CT abdomen Fig. 1 supported this common presentation by revealing a small volume ascites. Moreover, clinical awareness of pseudocirrhosis is warranted when hormone therapy and cytotoxic chemotherapy are both administered1. Given the significant risk of portal hypertension complications and the increased morbidity and mortality with 5/6 patients being dead within weeks to months as reported in one case series2, an increased demand for early recognition and monitoring is needed.