Metastases can occur in cirrhotic livers with patent portal veins

• Authors: Zaid Mahdi, Emory University; Mark G Ettel, University of Rochester; Raul Gonzalez, Emory University; John Hart, University of Chicago; Linday Alpert, University of Chicago; Jiayun Fang, University of Michigan; Natalia Liu, University of Michigan; Suntrea T Hammer, Univ Texas Southwestern Med Ctr Dallas; Nicole Panarelli, Montefiore Medical Center, Bronx; Jerome Cheng, University of Michigan; Joel K Greenson, University of Michigan; Paul E Swanson, University of Washington; Maria Westerhoff, University of Michigan
• Journal Title: DIAGNOSTIC PATHOLOGY
• Volume: Volume 16, Number 1
• Publisher: BMC | 2021-02-27, Pages 18-18
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s13000-021-01076-5
• Subjects: Health Sciences, Pathology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pathology; Liver; Metastases; Liver mass; Laennec staging; Cirrhosis; HEPATIC METASTASES; COLORECTAL-CANCER; CARCINOMA; LECTINS; ADHESION

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.