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Author Notes:

Maria Westerhoff, Email:mwesterh@med.umich.edu

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Zaid Mahdi, Mark G. Ettel and Maria Westerhoff. The first draft of the manuscript was written by Zaid Mahdi and Mark Ettel (co-first authors) and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

The authors declare that they have no conflict of interest.


Research Funding:

No outside funding received.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Pathology
  • Liver
  • Metastases
  • Liver mass
  • Laennec staging
  • Cirrhosis

Metastases can occur in cirrhotic livers with patent portal veins

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Journal Title:



Volume 16, Number 1


, Pages 18-18

Type of Work:

Article | Final Publisher PDF


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.

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© The Author(s) 2021

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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