N Alberti1, D Bechade2, F Dupuis3, A Crombe4, A Neuville3, M Debled2, J Palussiere5, X Buy5, J-T Perez5, M Desjardin2, N Frulio4, M Kind5. 1. Department of Radiology, Institut Bergonié, Comprehensive Cancer Center, 229, cours de l'Argonne, 33000 Bordeaux, France. Electronic address: nicoalbertibdx@gmail.com. 2. Department of Oncology, Institut Bergonié, Comprehensive Cancer Center, 229, cours de l'Argonne, 33000 Bordeaux, France. 3. Department of Pathology, Institut Bergonié, Comprehensive Cancer Center, 229, cours de l'Argonne, 33000 Bordeaux, France. 4. Department of Radiology, CHU de Bordeaux, Hôpital Saint-André, 1, rue Burguet, 33075 Bordeaux, France. 5. Department of Radiology, Institut Bergonié, Comprehensive Cancer Center, 229, cours de l'Argonne, 33000 Bordeaux, France.
Abstract
BACKGROUNDS AND AIMS: Hepar lobatum carcinomatosum (HLC) is an exceptional acquired hepatic distortion which consists in irregularly lobulated hepatic contours seen in patients with known liver metastases, usually from breast carcinoma. We aimed to describe and analyze five similar cases of HLC resulting from metastatic mammary carcinoma in the liver and associated with rapid hepatic failure. METHODS: Five cases of HLC were investigated. Medical (including blood liver tests), radiological and histological data (2 cases) were collected and retrospectively analyzed. All patients were followed up for metastatic invasive ductal carcinoma of the breast and had a common pattern of treatment with combination of targeted therapies (bevacizumab, AVASTIN) and chemotherapy (paclitaxel, TAXOL). RESULTS: All the patients showed rapid hepatic failure after a mean of 9 courses of bevacizumab/paclitaxel. In all cases, liver imaging revealed liver capsule retraction and an irregular lobular margin. An apparent tumor regression of all liver metastases was showed in two cases. Biopsies were consistent with sinusoidal obstruction syndrome (SOS) and, surprisingly, no tumoral cells were found. CONCLUSION: Although rare, such an unusual pattern of liver metastasis may mimick acute cirrhosis and cause rapid hepatic failure in patients, despite possible apparent tumor regression on imaging. The etiology of this pathology is unclear, and may involve multiple pathogenic factors. Direct or indirect vascular injury plays an important role in the development of HLC.
BACKGROUNDS AND AIMS: Hepar lobatum carcinomatosum (HLC) is an exceptional acquired hepatic distortion which consists in irregularly lobulated hepatic contours seen in patients with known liver metastases, usually from breast carcinoma. We aimed to describe and analyze five similar cases of HLC resulting from metastatic mammary carcinoma in the liver and associated with rapid hepatic failure. METHODS: Five cases of HLC were investigated. Medical (including blood liver tests), radiological and histological data (2 cases) were collected and retrospectively analyzed. All patients were followed up for metastatic invasive ductal carcinoma of the breast and had a common pattern of treatment with combination of targeted therapies (bevacizumab, AVASTIN) and chemotherapy (paclitaxel, TAXOL). RESULTS: All the patients showed rapid hepatic failure after a mean of 9 courses of bevacizumab/paclitaxel. In all cases, liver imaging revealed liver capsule retraction and an irregular lobular margin. An apparent tumor regression of all liver metastases was showed in two cases. Biopsies were consistent with sinusoidal obstruction syndrome (SOS) and, surprisingly, no tumoral cells were found. CONCLUSION: Although rare, such an unusual pattern of liver metastasis may mimick acute cirrhosis and cause rapid hepatic failure in patients, despite possible apparent tumor regression on imaging. The etiology of this pathology is unclear, and may involve multiple pathogenic factors. Direct or indirect vascular injury plays an important role in the development of HLC.
Authors: Caspian Oliai; Michael L Douek; Caelainn Rhoane; Abhishek Bhutada; Phillip S Ge; Bruce A Runyon; Xiaoyan Wang; Sara A Hurvitz Journal: Breast Cancer Res Treat Date: 2019-06-07 Impact factor: 4.872