Metastatic carcinomatous cirrhosis from diffuse breast cancer liver metastasis: a case report

Metastatic carcinomatous cirrhosis is a rare condition associated with several malignancies. It is characterized by diffuse hepatic tumor infiltration, leading to rapid progression to liver failure. We report a case of metastatic carcinomatous cirrhosis caused by diffuse hepatic metastasis from breast cancer and describe the computed tomography (CT), magnetic resonance imaging (MRI), and histopathological findings. A woman in her 50s who had undergone left mastectomy with reconstruction for breast cancer 9 years prior presented with fatigue and abdominal distension. Following the initial surgery, she received adjuvant hormone therapy. Five years prior to presentation, a local recurrence at the surgical site was detected and surgically resected; thereafter, she was followed up without additional treatment. At presentation, non-contrast CT revealed massive ascites, prompting further evaluation with contrast-enhanced dynamic CT and gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. Imaging showed a cirrhosis-like morphology, suggesting pseudocirrhosis. However, considering the absence of previously documented hepatic metastases and no history of chemotherapy, metastatic carcinomatous cirrhosis was suspected. A transjugular liver biopsy confirmed the diagnosis, revealing extensive tumor infiltration of the portal areas accompanied by fibrosis and scar formation that dissected the hepatic parenchyma. In patients with malignancies who develop rapidly progressive liver dysfunction and cirrhosis-like imaging findings, metastatic carcinomatous cirrhosis should be considered in the differential diagnosis. Additionally, recognizing this entity that represents a pathophysiology distinct from that of pseudocirrhosis is crucial, despite their similar morphological appearances on imaging.