Download Pseudocirrhosis of the liver due to chemotherapeutic drug toxicity

Pseudocirrhosis of the liver due to chemotherapeutic drug
toxicity
Poster No.:
C-1035
Congress:
ECR 2014
Type:
Educational Exhibit
Authors:
E.-M. Heursen, M. J. Calvo López; Cádiz/ES
Keywords:
Toxicity, Drugs / Reactions, Cirrhosis, Complications,
Chemotherapy, MR, CT, Liver, Abdomen
DOI:
10.1594/ecr2014/C-1035
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Learning objectives
Pseudocirrhosis is a radiologic term that describes morphologic changes in liver
parenchyma due to the toxicity of some chemotherapeutic drugs[i]. It is seen in patients
with liver metastasis, mostly from breast cancer.This side effect is rare and not well
known since only a few publications discuss it. Importantly, radiologists have to know
it since the imaging findings are readily confounded with a progression of underlying
malignancy. Patients with pseudocirrhosis have a high risk of liver failure and changing
the chemotherapeutic regimen can prevent early death.
Background
Pseudocirrhosis is a radiologic term that describes morphologic changes in liver
parenchyma due to the toxicity ofsome chemotherapeutic drugs. It is seen in patients
with liver metastasis, mostly from breast cancer.This side effect is rare and not well
known since only a few publications discuss it. Importantly, radiologists have to know
it since the imaging findings are readily confounded with a progression of underlying
malignancy. Patients with pseudocirrhosis have a high risk of liver failure and changing
the chemotherapeutic regimen can prevent early death.
Findings and procedure details
The term pseudocirrhosis refers to a liver parenchyma resembling macronodular cirrhosis
due to retracted tumor tissue and scarring between areas of regenerative parenchyma[i].
These morphologic changes are caused by a combination of degenerating liver
metastasis and direct hepatototoxic effects of chemotherapy. The shrinkage and
distortion of the liver can be indistinguishable from end stage liver disease. It typically
occurs within a few months after the onset of chemotherapy. Analytic parameters can
be normal in the beginning but if the cytotoxic therapy continues, patients can end up
with liver failure. In some documented cases, the discontinuation of chemotherapy lead
to acomplete restitution.
Most of the patients suffer from metastatic breast cancer but cases of pseudocirrhosis in
patients with lymphoma, melanoma, renal or lung cancer, liver metastasis paired with a
prolonged chemotherapy were also described in the literature. Pseudocirrhosis can be a
side effect of different therapy regimens, for example Placitaxel, Trastuzumab, Docetaxel
or Cisplatin.
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Imaging findings are similar to those of normal cirrhosis, including diffuse nodularity,
enlargement of the caudate lobe and even portal hypertension with ascites[ii][iii]. More
specific findings are multifocal capsule retraction due to degenerating liver metastasis.
Typically the cirrhosis progresses rapidly in patients with no underlying hepatopathy but
a history of chemotherapy. The only way to distinguish pseudocirrhosis from real liver
cirrhosis is a liver biopsy. Histological findings in pseudocirrhosis differ from real cirrhosis
in the presence of bridging fibrosis in real cirrhotic liver parenchyma[iv]. We present
images from abdominal sonography and abdominal contrast enhanced multy detector CT
(MDCT) of cases from our centre. The pre- and post treatment findings are documented
(Figure 1 to 6).
Images for this section:
Fig. 1: 40 year old female with metastatic breast cancer. No history of liver disease.
Pre treatment abdominal CT. Liver with normal morphology. Some hypodense liver
metastasis.
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Fig. 2: Same patient at the beginning of Chemotherapy (Capecitabine and later
Doxorubicin).
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Fig. 3: Same patient, three months after starting of Chemotherapy. Discrete lobulation
of hepatic surface.
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Fig. 4: Same patient, 9 months after onset of chemotherapy. Diffuse hepatic shrinkage
and lobulation. Perihepatic ascitis.
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Fig. 5: Another patient, female with metastatic breast cancer. Abdominal sonography
before chemotherapy shows morphologically normal liver with metastasis.
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Fig. 6: The same patient, only three month later. Chemotherapy has been given for about
two month. The image shows lobulation of the liver contours, volume loss of the organ
and important ascitis.
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Conclusion
Radiologists shouldbe aware of the risk of developing pseudocirrhosis in certain patients
with chemotherapy due to liver metastasis. It is important to know this diagnosis and to
communicate it to the attending physician so that the chemotherapeutic regimen can be
changed early.
Personal information
References
[1] Woo Kyoung Jeong, Seo-Youn Choi and Jinoo Kim, 'Pseudocirrhosis as a
Complication after Chemotherapy for Hepatic Metastasis from Breast Cancer', Clinical
and molecular hepatology, 19 (2013), 190-194 <doi:10.3350/cmh.2013.19.2.190>.
[1] Wolfgang Dähnert, Radiology Review Manual (Lippincott Williams & Wilkins, 2011).
[1] S. M. and others, 'The Assessment and Management of Chemotherapy
Associated Liver Injury', in Hepatic Surgery, ed. by Hesham Abdeldayem
(InTech, 2013) <http://www.intechopen.com/books/hepatic-surgery/the-assessmentand-management-of-chemotherapy-associated-liver-injury> [accessed 29 December
2013].
[1] Jean M Torrisi and others, 'CT Findings of Chemotherapy-Induced Toxicity: What
Radiologists Need to Know about the Clinical and Radiologic Manifestations of
Chemotherapy Toxicity', Radiology, 258 (2011), 41-56 <doi:10.1148/radiol.10092129>.
[1] M. and others.
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