Diffuse Intrasinusoidal Hepatic Metastasis From Occult Breast Carcinoma Presenting as Thrombotic Microangiopathy: A Case Report and Literature Review

Abstract

We report a case of a 37-year-old female presenting with microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. Two years ago, she had left breast ductal carcinoma in situ (DCIS) treated with surgical resection and adjuvant radiotherapy. Radiological imaging showed numerous patchy hepatic infiltrating lesions, but no discrete mass lesion. Liver biopsy revealed diffuse intrasinusoidal hepatic metastases (DISH) from a poorly differentiated carcinoma, which stained strongly positive for cerbB2. The patient was treated for metastatic breast carcinoma with improvement in her MAHA and thrombocytopenia. DISH is a rare mode of cancer spread, and is often radiologically occult. Recognition of atypical presentations of metastatic carcinoma in patients who present with clinical features of thrombotic microangiopathy (TMA) is crucial to avoid futile and potentially dangerous interventions. In our patient, prompt liver biopsy yielded a diagnosis of metastatic liver malignancy with secondary TMA within 3 days of admission, and the patient was appropriately started on chemotherapy.




J Hematol. 2015;4(4):238-241
doi: http://dx.doi.org/10.14740/jh230w