title: Portal Hypertension, Nodular Regenerative Hyperplasia of the Liver, and Obstructive Portal Venopathy due to Metastatic Breast Cancer.
abstract: Nodular regenerative hyperplasia (NRH) of the liver is associated with noncirrhotic portal hypertension, rheumatologic and hematologic disorders, administration of certain drugs, and other underlying conditions. This report describes a 64-year-old man with clinically presumed cirrhosis who presented to our institution with coffee-ground emesis, esophageal varices, ascites, and encephalopathy. Eleven years earlier he had been treated for breast cancer with mastectomy and chemo-radiotherapy. He died suddenly, and the autopsy showed no evidence of cirrhosis but instead demonstrated NRH with extensive emboli of recurrent breast carcinoma within the portal vein and its intrahepatic branches. Neoplastic occlusion of the portal vein as a cause of presinusoidal noncirrhotic portal hypertension has not previously been reported for metastatic breast carcinoma. This case highlights the importance of obstructive portal venopathy in the pathogenesis of NRH as well as the diagnostic difficulties that may be encountered in determining the cause of portal hypertension.
authors: Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA.
authors: Andrew T
authors: AT
authors: Turk
authors: Matthias J
authors: MJ
authors: Szabolcs
authors: Jay H
authors: JH
authors: Lefkowitch
references: J Hepatol. 1998 Sep;29(3):485-8
references: 9764999
references: Hepatology. 2011 Sep 2;54(3):1071-81
references: 21574171
references: Hepatology. 2006 Jul;44(1):7-14
references: 16799965
references: Acta Medica (Hradec Kralove). 2009;52(4):163-6
references: 20369711
references: AJR Am J Roentgenol. 1981 May;136(5):897-900
references: 6784524
references: Am J Mens Health. 2012 Jan;6(1):51-8
references: 21831929
references: Cardiovasc Intervent Radiol. 2009 May;32(3):462-70
references: 18956224
references: Intern Med. 2009;48(10):805-8
references: 19443975
references: Hepatology. 1990 May;11(5):787-97
references: 2189821
references: Am J Med. 1992 Feb;92(2):173-82
references: 1543202
references: Lancet. 2006 Feb 18;367(9510):595-604
references: 16488803
references: HPB Surg. 1994;8(1):53-6
references: 7993865