Metastases can occur in cirrhotic livers with patent portal veins

Diagnostic Pathology

Raul S. Gonzalez¹  Zaid Mahdi²  Nicole Panarelli³  Lindsay Alpert⁴  John Hart⁴  Joel K. Greenson⁵  Natalia Liu⁵  Maria Westerhoff⁵  Jerome Cheng⁵  Jiayun Fang⁵  Mark G. Ettel⁶  Suntrea T. Hammer⁷  Paul E. Swanson⁸ 

[1] Department of Pathology, Beth Israel Deaconness Medical Center, Boston, MA, USA;Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA;Department of Pathology, Montefiore Medical Center, Bronx, NY, USA;Department of Pathology, University of Chicago, Chicago, IL, USA;Department of Pathology, University of Michigan, Faculty Suite Rm. 36-1221-65 2800 Plymouth Rd, Building 35, 48109, Ann Arbor, MI, USA;Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA;Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA;Department of Pathology, University of Washington, Seattle, WA, USA;

关键词: Liver;    Metastases;    Liver mass;    Laennec staging;    Cirrhosis;   

DOI  :  10.1186/s13000-021-01076-5

来源: Springer

【 摘 要 】

ObjectivesMetastases are common in non-cirrhotic livers but are considered unlikely in the setting of cirrhosis. However, the degree of fibrosis in cirrhosis may vary; thus metastases may still access the liver vasculature and present as a mass in cirrhotic livers. This possibility may affect pathologists’ diagnostic algorithms when faced with a liver mass biopsy.MethodsWe hypothesized that metastases can occur in cirrhotic livers if fibrous remodeling is not severe or abnormal veno-arterial shunting exists to override an obstructed portal system. We searched departmental archives for cirrhotic livers with masses, categorizing fibrosis by Laennec staging: 4A = mild cirrhosis, 4B = moderate, 4 C = severe.ResultsOf 1453 cirrhotic livers with masses, 1429 were primary tumors and 24 were metastases (1.7 %). Of livers with metastases, most had 4A or 4B cirrhosis by Laennec staging (n = 17; 71 %). Eleven patients were evaluated by ultrasound Doppler; 2 of 5 with Laennec 4 C had reversal of portal vein flow, but all 4A & 4B patients had patent portal veins without reversed flow. Echocardiograms (13 patients) showed no ventricular or atrial septal defects or arteriovenous shunts.ConclusionsMetastases are uncommon in cirrhotic livers, accounting for 1.7 % of masses. Most involved livers had mild or moderate cirrhosis (Laennec 4A/4B) and patent portal veins; however, as some Laennec 4 C cases also contained metastases, obstructed portal access may not be enough to deter metastatic access.

【 授权许可】

CC BY