Presentation
Advanced breast cancer. Elevated liver enzymes. Has been receiving chemotherapy. Follow-up CT.
Patient Data
No evidence of metastatic disease to lungs or mediastinum (not shown).
Heterogeneously enhancing liver with lobular contour. Small amount of perihepatic fluid.
Innumerable lytic and blastic bone metastases.
Bilateral elastofibroma dorsi.
Small simple renal cysts, right kidney.
Old fractures in several consecutive ribs bilaterally and in the pubis. Internal fixation of right femoral neck and total left hip replacement.
Previous CT (3 years prior) for comparison:
The liver is riddled with innumerable small hypodense metastases. Liver contour is smooth.
Widespread skeletal metastases.
Heterogeneous liver with lobulated contour and diffuse macronodular appearance, including capsular retraction. In both hepatic lobes are areas with high T1 / low T2 signal that exhibit contrast enhancement on the late postcontrast venous phase. All of these findings are not seen on the CT from three years prior and are most consistent with pseudocirrhosis, most probably with fibrotic changes and possibly neoplastic (metastatic) infiltrate as well.
Free intraperitoneal fluid in the upper abdomen.
Left adrenal slightly thickened, without a discrete nodule, unchanged.
Several renal cysts up to 30 cm in diameter in the right kidney, several tiny cysts in the left kidney.
Widespread skeletal metastases
In conclusion:
Pseudocirrhosis: complication of treated hepatic metastases.
Case Discussion
Elderly patient receiving chemotherapy for breast cancer metastatic to the liver and the skeleton.
The hepatologist decided against liver biopsy for metastases since the disease was advanced and widespread and the patient was receiving chemotherapy anyhow. However, serology for HBA and HCV was negative and cirrhosis was ruled out clinically. In addition, there was no evidence of splenomegaly or collateral vessels on the cross-sectional studies.
All of these findings combined are strongly in favor of pseudocirrhosis.
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