D0551 - The Great Imitator: A Case of Pseudocirrhosis in Metastatic Breast Cancer

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Amanda Eisinger, DO

SUNY Upstate Medical University
Syracuse, NY

Amanda Eisinger, DO¹, Vishnu Kumar, MD¹, Pujitha Kudaravalli, MBBS², Kathleen L. Donovan, MD¹, Ganesh Aswath, MD²
¹SUNY Upstate Medical University, Syracuse, NY; ²State University of New York Upstate University Hospital, Syracuse, NY

Introduction: Pseudocirrhosis (PC) is the radiographic appearance of cirrhosis without corresponding histologic findings, usually in patients with metastatic cancer.  We present a case of PC in a patient with metastatic breast cancer, which mimicked decompensated cirrhosis.

Case Description/Methods: A 69-year-old female with stage IV ER+ breast cancer and metastatic disease to the liver and spine presented to the ED for intermittent RUQ pain with associated nausea and decreased oral intake for one week. She had no history of cirrhosis and no risk factors for the development of cirrhosis. Her lab work on presentation is shown in table 1. Imaging including CT/MRCP showed numerous liver lesions consistent with known metastatic disease, which had decreased in size as compared to the previous study and perihepatic ascites but was negative for biliary pathology. PC was suspected because of nodular liver contour, asymmetric enlargement of the left and caudate lobes, and prominent fissures. Imaging one year prior did not demonstrate evidence of cirrhosis (Figure 1). Given her worsening liver enzymes, bilirubin, and thrombocytopenia, we suspected the patient had PC on top of underlying intrahepatic cholestasis from liver metastasis. A non-targeted liver biopsy was obtained, which showed poorly differentiated adenocarcinoma of the breast with surrounding normal liver parenchyma without any evidence of cirrhosis or advanced fibrosis.

Discussion: PC is a radiological diagnosis in which the morphological changes of the liver closely mimic cirrhosis; without the typical histopathological changes seen on biopsy. It most commonly occurs in patients with metastatic breast cancer, although it has also been reported in other malignancies. Portal hypertension is often seen in patients with PC. The prevalence of PC in patients with metastatic breast cancer is thought to be up to 50%. The pathophysiology leading to the formation of PC is not clearly understood. In chemotherapy-naive patients, it has been associated with a desmoplastic reaction. In patients who received chemotherapy, it has been attributed to tumor necrosis, development of nodular regenerative hyperplasia, or sinusoidal obstruction syndrome (SOS). Identifying this condition early on is crucial as it carries the same complications and clinical progression as cirrhosis. Further studies are required to help us understand this entity better.

Figure: A. CT one year prior to presentation demonstrating interval improvement in liver lesions with no evidence of cirrhosis B. Axial T2 image demonstrating extensive hepatic metastases, a nodular liver contour (arrowhead) and caudate lobe hypertrophy (arrow), findings consistent with pseudocirrhosis

AST (U/L)	280
ALT (U/L)	98
Total Bilirubin (mg/dL)	18.6
Direct Bilirubin (mg/dL)	14.6
INR	1.3
Platelets (/uL)	190
Albumin (g/dL)	3.0
Creatinine (mg/dL)	2.15

Table: Laboratory Results at Presentation

Disclosures:

Amanda Eisinger indicated no relevant financial relationships.

Vishnu Kumar indicated no relevant financial relationships.

Pujitha Kudaravalli indicated no relevant financial relationships.

Kathleen Donovan indicated no relevant financial relationships.

Ganesh Aswath indicated no relevant financial relationships.

Amanda Eisinger, DO¹, Vishnu Kumar, MD¹, Pujitha Kudaravalli, MBBS², Kathleen L. Donovan, MD¹, Ganesh Aswath, MD². D0551 - The Great Imitator: A Case of Pseudocirrhosis in Metastatic Breast Cancer, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.