Diffuse intrasinusoidal hepatic metastasis from breast cancer: Multimodality imaging with pathology correlation

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Breast cancer commonly metastasizes to the liver, typically as focal masses.
• Hepatic metastases can rarely present as diffuse intrasinusoidal infiltration, posing diagnostic challenges.

Observation:

• A 28-year-old female with stage III invasive ductal carcinoma, who paused treatment for pregnancy, presented with liver failure symptoms.
• Imaging revealed no focal liver metastases but did show intrahepatic vein compression.
• Liver biopsy confirmed diffuse hepatic sinusoidal tumor infiltration.

Findings:

• The patient's condition initially suggested sinusoidal obstruction syndrome due to tumor infiltration.
• Palliative chemotherapy led to a change in the metastatic pattern, making it more conspicuous as focal hepatic metastases.
• Treatment also resolved intrahepatic vein compression and liver failure symptoms.

Implications:

• This case underscores the importance of considering rare intrasinusoidal patterns in hepatic metastatic disease, especially in patients with breast cancer.
• Multimodality imaging and biopsy are essential for diagnosing challenging presentations of liver metastases.
• Recognizing and treating diffuse sinusoidal infiltration can prevent or reverse liver failure in metastatic breast cancer.