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Case report
Recurrent metastatic breast cancer presenting with portal hypertension and pseudocirrhosis
  1. Maciej Adler1,
  2. Ivan Tang1,
  3. Michael William Gach1 and
  4. George MacFaul2
  1. 1Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
  2. 2Department of Gastroenterology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
  1. Correspondence to Dr Maciej Adler; maciej.adler{at}nhs.net

Abstract

We present a case of a 63-year-old woman with an acute history of abdominal distension and shortness of breath. She had no risk factors for liver disease though her prior medical history was positive for breast carcinoma, in remission for 14 years. Examination and investigations were initially consistent with decompensated cirrhosis, thought to be due to subclinical autoimmune hepatitis. Imaging revealed hepatic contour irregularity, atrophy of the liver parenchyma and numerous lesions highly suggestive for multifocal hepatocellular carcinoma. Surprisingly, tissue histology revealed no evidence of cirrhosis, but recurrence of breast cancer which had mimicked cirrhosis. Pseudocirrhosis may be indistinguishable from true cirrhosis without histopathology. It has previously been linked to chemotherapy-induced hepatic injury and nodular regenerative hyperplasia, although our case illustrates an uncommon pathophysiology. Pseudocirrhosis often represents a poor prognosis even with a good baseline performance status, and early involvement of palliative care specialists may be advisable.

  • Cirrhosis
  • Breast cancer
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Footnotes

  • Contributors MA and IT were responsible for conception, consent and manuscript drafting. MWG was responsible for data and imaging acquisition and manuscript review. GM was the patient’s lead consultant and was responsible for manuscript review and clinical accuracy.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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