Metastases can occur in cirrhotic livers with patent portal veins
Abstract Objectives Metastases 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 aff...
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doaj-35171294369646f684301331c03db1892021-03-11T11:56:04ZengBMCDiagnostic Pathology1746-15962021-02-0116111010.1186/s13000-021-01076-5Metastases can occur in cirrhotic livers with patent portal veinsZaid Mahdi0Mark G. Ettel1Raul S. Gonzalez2John Hart3Lindsay Alpert4Jiayun Fang5Natalia Liu6Suntrea T. Hammer7Nicole Panarelli8Jerome Cheng9Joel K. Greenson10Paul E. Swanson11Maria Westerhoff12Department of Pathology, Emory University School of MedicineDepartment of Pathology, University of Rochester Medical CenterDepartment of Pathology, Beth Israel Deaconness Medical CenterDepartment of Pathology, University of ChicagoDepartment of Pathology, University of ChicagoDepartment of Pathology, University of MichiganDepartment of Pathology, University of MichiganDepartment of Pathology, University of Texas Southwestern Medical CenterDepartment of Pathology, Montefiore Medical CenterDepartment of Pathology, University of MichiganDepartment of Pathology, University of MichiganDepartment of Pathology, University of WashingtonDepartment of Pathology, University of MichiganAbstract Objectives Metastases 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. Methods We 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. Results Of 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. Conclusions Metastases 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.https://doi.org/10.1186/s13000-021-01076-5LiverMetastasesLiver massLaennec stagingCirrhosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zaid Mahdi Mark G. Ettel Raul S. Gonzalez John Hart Lindsay Alpert Jiayun Fang Natalia Liu Suntrea T. Hammer Nicole Panarelli Jerome Cheng Joel K. Greenson Paul E. Swanson Maria Westerhoff |
spellingShingle |
Zaid Mahdi Mark G. Ettel Raul S. Gonzalez John Hart Lindsay Alpert Jiayun Fang Natalia Liu Suntrea T. Hammer Nicole Panarelli Jerome Cheng Joel K. Greenson Paul E. Swanson Maria Westerhoff Metastases can occur in cirrhotic livers with patent portal veins Diagnostic Pathology Liver Metastases Liver mass Laennec staging Cirrhosis |
author_facet |
Zaid Mahdi Mark G. Ettel Raul S. Gonzalez John Hart Lindsay Alpert Jiayun Fang Natalia Liu Suntrea T. Hammer Nicole Panarelli Jerome Cheng Joel K. Greenson Paul E. Swanson Maria Westerhoff |
author_sort |
Zaid Mahdi |
title |
Metastases can occur in cirrhotic livers with patent portal veins |
title_short |
Metastases can occur in cirrhotic livers with patent portal veins |
title_full |
Metastases can occur in cirrhotic livers with patent portal veins |
title_fullStr |
Metastases can occur in cirrhotic livers with patent portal veins |
title_full_unstemmed |
Metastases can occur in cirrhotic livers with patent portal veins |
title_sort |
metastases can occur in cirrhotic livers with patent portal veins |
publisher |
BMC |
series |
Diagnostic Pathology |
issn |
1746-1596 |
publishDate |
2021-02-01 |
description |
Abstract Objectives Metastases 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. Methods We 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. Results Of 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. Conclusions Metastases 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. |
topic |
Liver Metastases Liver mass Laennec staging Cirrhosis |
url |
https://doi.org/10.1186/s13000-021-01076-5 |
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