Imaging description

In patients with metastases to the liver from breast cancer, treatment with chemotherapy can result in diffuse hepatic nodularity (Figure 11.1). This entity is referred to as “pseudocirrhosis” because it resembles cirrhosis at cross-sectional imaging [1]. Features of portal hypertension such as portosytemic venous collaterals, splenomegaly, and bland ascites may also develop (Figure 11.2) [2]. This suggests that the prefix “pseudo” may itself be a misnomer, and that this condition may progress to more closely resemble true cirrhosis.

Importance

The erroneous diagnosis of cirrhosis in a patient with metastatic breast cancer could result in unnecessary workup or treatment. In addition, changes of pseudocirrhosis may greatly complicate or even preclude meaningful evaluation of the underlying metastases in the liver, and radiological therapeutic monitoring may depend on evaluating the response of extrahepatic disease sites. It is not known if pseudocirrhosis indicates treatment response and supports continuation of chemotherapy, or if these changes are harbingers of therapeutic toxicity that merit discontinuation or substitution of drug treatment.

Typical clinical scenario

Hepatic contour abnormalities were seen after a median follow-up interval of 15 months in 68 of 91 women (75%) with breast cancer metastatic to the liver who received chemotherapy [2]. Contour abnormalities consisted of limited retraction (n=42), widespread retraction (n=10), or diffuse nodularity (n=16). Even if the term pseudocirrhosis is restricted to those with diffuse nodularity, this would indicate a frequency of at least 18% (16 of 91) for the development of pseudocirrhosis in the population at risk. It is unclear why the phenomenon of pseudocirrhosis seems almost specific for breast cancer metastatic to the liver, with only sporadic reports of such changes in other primary malignancies such as colon or pancreas (Figures 11.3 and 11.4) [3, 4].