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01-09-2019 | Metastasis | Clinical trial

Clinical features of pseudocirrhosis in metastatic breast cancer

Authors: Caspian Oliai, Michael L. Douek, Caelainn Rhoane, Abhishek Bhutada, Phillip S. Ge, Bruce A. Runyon, Xiaoyan Wang, Sara A. Hurvitz

Published in: Breast Cancer Research and Treatment | Issue 2/2019

Abstract

Purpose

Pseudocirrhosis has been demonstrated to mimic cirrhosis radiographically, but studies evaluating the pathophysiology and clinical features are lacking. To better understand the incidence, risk factors, clinical course, and etiology of pseudocirrhosis, we performed a retrospective analysis of consecutively treated patients with metastatic breast cancer (MBC).

Methods

Of 374 patients treated for MBC from 2006 to 2012, 199 had imaging available for review. One radiologist evaluated computed tomography scans for evidence of pseudocirrhosis. Features of groups with and without pseudocirrhosis were compared by Kaplan–Meier product-limit survival estimates and log-rank tests. Wilcoxon Rank-Sum testing evaluated if patients more heavily treated were more likely to develop pseudocirrhosis. Univariate and multivariate Cox proportional hazard models investigated factors associated with mortality.

Results

Pseudocirrhosis developed in 37 of 199 patients (19%). Of the patients with liver metastases, 55% developed pseudocirrhosis. Liver metastases were demonstrated in 100% of patients with pseudocirrhosis. Survival in the subset with liver metastases favored those without pseudocirrhosis, 189 versus 69 months (p = 0.01). The number of systemic regimens received were higher in patients with pseudocirrhosis (p = 0.01). Ascites was demonstrated in 68%, portal hypertension in 11%, and splenomegaly in 8% of patients with pseudocirrhosis.

Conclusions

Pseudocirrhosis does not occur in the absence of liver metastases, can manifest as hepatic decompensation, and appears to be associated with poorer survival amongst patients with hepatic metastases. Higher cumulative exposure to systemic therapy may be causative, instead of the previously held belief of pseudocirrhosis as an adverse effect of a particular systemic agent/class.

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Chia SK, Speers CH, D’yachkova Y et al (2007) The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer 110(5):973–979CrossRefPubMed

Sharma A, Houshyar R, Bhosale P et al (2014) Chemotherapy induced liver abnormalities: an imaging perspective. Clin Mol Hepatol 20(3):317–326CrossRefPubMedPubMedCentral

Busni NA (1924) Hepar lobatum carcinomatosum. Virchows Arch A Pathol Anat Histopathol 252:727–733CrossRef

Symmers D, Spain DM (1946) Hepar lobatum: clinical significance of the anatomic changes. Arch Pathol 42:64–68

Honma K (1987) Hepar lobatum carcinomatosum due to metastatic breast carcinoma. Virchows Arch A Pathol Anat Histopathol 410(6):465–469PubMed

Lee SL, Chang ED, Na SJ et al (2014) Pseudocirrhosis of breast cancer metastases to the liver treated by chemotherapy. Cancer Res Treat 46(1):98–103CrossRefPubMedPubMedCentral

Battisti S, Guida FM, Pagliara E et al (2014) Pseudocirrhosis after anti-EGFR-based neoadjuvant therapy for hepatic metastasis from colon cancer: a different point of view. Clin Colorectal Cancer 13(3):e13–e15CrossRefPubMed

Jeong WK, Choi SY, Kim J (2013) Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer. Clin Mol Hepatol 19(2):190–194CrossRefPubMedPubMedCentral

Teke Z, Nessar G, Kiremitci S et al (2011) Hepar lobatum carcinomatosum associated with metastatic rectal carcinoma: an unusual cause of liver dysmorphy. Med Princ Pract 20(1):93–96CrossRefPubMed

10.

Graber I, Dumortier J, Poncet G et al (2010) Hepar lobatum carcinomatosum revealing an occult metastatic lobular carcinoma of the breast. Ann Diagn Pathol 14(6):438–442CrossRefPubMed

11.

Sass DA, Clark K, Grzybicki D et al (2007) Diffuse desmoplastic metastatic breast cancer simulating cirrhosis with severe portal hypertension: a case of “pseudocirrhosis”. Dig Dis Sci 52(3):749–752CrossRefPubMed

12.

Nakajima T, Sekoguchi S, Nishikawa T et al (2005) Multifocal intraportal invasion of breast carcinoma diagnosed by laparoscopy-assisted liver biopsy. World J Gastroenterol 11(15):2360–2363CrossRefPubMedPubMedCentral

13.

Chandrakar V, Isaacs C (2005) Breast cancer-related pseudocirrhosis and esophageal varices. Breast J 11(4):301–302CrossRefPubMed

14.

Nascimento AB, Mitchell DG, Rubin R et al (2001) Diffuse desmoplastic breast carcinoma metastases to the liver simulating cirrhosis at MR imaging: report of two cases. Radiology 221(1):117–121CrossRefPubMed

15.

Alberti N, Bechade D, Dupuis F et al (2015) Hepar lobatum carcinomatosum associated with liver metastases from breast cancer: report of five cases. Diagn Interv Imaging 96(1):73–78CrossRefPubMed

16.

Sonnenblick A, Appelbaum L, Peretz T (2011) Liver failure on the background of pseudocirrhosis in patients with liver metastasis from breast cancer, who responded to treatment. Onkologie 34(4):199–201CrossRefPubMed

17.

Qayyum A, Lee GK, Yeh BM et al (2007) Frequency of hepatic contour abnormalities and signs of portal hypertension at CT in patients receiving chemotherapy for breast cancer metastatic to the liver. Clin Imaging 31(1):6–10CrossRefPubMed

18.

Fennessy FM, Mortele KJ, Kluckert T et al (2004) Hepatic capsular retraction in metastatic carcinoma of the breast occurring with increase or decrease in size of subjacent metastasis. AJR Am J Roentgenol 182(3):651–655CrossRefPubMed

19.

Soyer P, Bluemke DA, Vissuzaine C et al (1994) CT of hepatic tumors: prevalence and specificity of retraction of the adjacent liver capsule. AJR Am J Roentgenol 162(5):1119–1122CrossRefPubMed

20.

Young ST, Paulson EK, Washington K et al (1994) CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis. AJR Am J Roentgenol 163(6):1385–1388CrossRefPubMed

21.

Jha P, Poder L, Wang ZJ et al (2010) Radiologic mimics of cirrhosis. AJR Am J Roentgenol 194(4):993–999CrossRefPubMed

22.

Lipson JA, Qayyum A, Avrin DE et al (2005) CT and MRI of hepatic contour abnormalities. AJR Am J Roentgenol 184(1):75–81 (Review. Erratum in: AJR Am J Roentgenol. 2005 Mar;184(3):1028) CrossRefPubMed

23.

Harry BL, Smith ML, Burton JR Jr et al (2012) Medullary thyroid cancer and pseudocirrhosis: case report and literature review. Curr Oncol 19(1):e36–e41CrossRefPubMedPubMedCentral

24.

Kang SP, Taddei T, McLennan B et al (2008) Pseudocirrhosis in a pancreatic cancer patient with liver metastases: a case report of complete resolution of pseudocirrhosis with an early recognition and management. World J Gastroenterol 14(10):1622–1624CrossRefPubMedPubMedCentral

25.

Zotti S, Piccigallo E, Rampinelli L et al (1986) Primary and metastatic tumors of the liver associated with cirrhosis. A study based on laparoscopy and autopsy. Gastrointest Endosc 32(2):91–95CrossRefPubMed

26.

Uhlmann F, Martin H, Ringk H et al (1996) Hepar lobatum carcinomatosum due to chemotherapy of a metastatic breast carcinoma. Gen Diagn Pathol 141(3–4):279–284 (Review) PubMed

27.

Shirkhoda A, Baird S (1994) Morphologic changes of the liver following chemotherapy for metastatic breast carcinoma: CT findings. Abdom Imaging 19(1):39–42CrossRefPubMed

28.

Micolonghi T, PPineda E, Stanley MM (1958) Metastatic carcinomatous cirrhosis of the liver; report of a case in which death followed hemorrhage from esophageal varices and hepatic coma. AMA Arch Pathol 65(1):56–62PubMed

29.

Amtrup F (1971) Metastatic carcinomatous liver cirrhosis. Dan Med Bull 18(2):46–48PubMed

30.

Cracium EC, Aslan A, Caffe L (1931) Cirrhose atrophique neoplastique secondaire. Ann Anat Pathol 8:1089–1112

31.

Wegener F (1961) Metastatisch-krebsige leberzirrhose. Acta Hepatosplenol 8:14–24PubMed

32.

Chin NW, Chapman I, Jimenez FA (1987) Complete chemotherapeutic regression of hepatic metastases with resultant hepar lobatum. Am J Gastroenterol 82(2):149–151PubMed

Title: Clinical features of pseudocirrhosis in metastatic breast cancer
Authors: Caspian Oliai
Michael L. Douek
Caelainn Rhoane
Abhishek Bhutada
Phillip S. Ge
Bruce A. Runyon
Xiaoyan Wang
Sara A. Hurvitz
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Metastasis
Breast Cancer
Breast Cancer
Systemic Therapy
Portal Hypertension
Portal Hypertension
Published in: Breast Cancer Research and Treatment / Issue 2/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-019-05311-y

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