Evidence map›Paper›PMID 33639984›Full record

ArticleDiagnostic pathology2021

Metastases can occur in cirrhotic livers with patent portal veins.

Zaid Mahdi, Mark G Ettel, Raul S Gonzalez, John Hart, Lindsay Alpert, Jiayun Fang, Natalia Liu, Suntrea T Hammer, Nicole Panarelli, Jerome Cheng and 3 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diagnostic pathology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
1.1field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 11 citations in OpenAlex.

  1. Review
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Hepatoid adenocarcinoma: A wolf in hepatocellular carcinoma's clothing.JGH open : an open access journal of gastroenterology and hepatology · 2022
    Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 1 country.

Zaid Mahdi *Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.
Mark G Ettel *Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
Raul S GonzalezDepartment of Pathology, Beth Israel Deaconness Medical Center, Boston, MA, USA.
John HartDepartment of Pathology, University of Chicago, Chicago, IL, USA.
Lindsay AlpertDepartment of Pathology, University of Chicago, Chicago, IL, USA.
Jiayun FangDepartment of Pathology, University of Michigan, Faculty Suite Rm. 36-1221-65 2800 Plymouth Rd, Building 35, 48109, Ann Arbor, MI, USA.
Natalia LiuDepartment of Pathology, University of Michigan, Faculty Suite Rm. 36-1221-65 2800 Plymouth Rd, Building 35, 48109, Ann Arbor, MI, USA.
Suntrea T HammerDepartment of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Nicole PanarelliDepartment of Pathology, Montefiore Medical Center, Bronx, NY, USA.
Jerome ChengDepartment of Pathology, University of Michigan, Faculty Suite Rm. 36-1221-65 2800 Plymouth Rd, Building 35, 48109, Ann Arbor, MI, USA.
Joel K GreensonDepartment of Pathology, University of Michigan, Faculty Suite Rm. 36-1221-65 2800 Plymouth Rd, Building 35, 48109, Ann Arbor, MI, USA.
Paul E SwansonDepartment of Pathology, University of Washington, Seattle, WA, USA.
Maria WesterhoffDepartment of Pathology, University of Michigan, Faculty Suite Rm. 36-1221-65 2800 Plymouth Rd, Building 35, 48109, Ann Arbor, MI, USA. mwesterh@med.umich.edu.
University of Michigan–Ann Arbor · USUniversity of Chicago · USBeth Israel Deaconess Medical Center · USEmory University · USMontefiore Medical Center · USThe University of Texas Southwestern Medical Center · USUniversity of Rochester Medical Center · USUniversity of Washington · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesMetastases 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.

methodsWe 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.

resultsOf 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.

conclusionsMetastases 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.

Indexed as

AgedBiopsyFemaleFibrosisHumansLiverLiver CirrhosisMaleMiddle AgedNeoplasm MetastasisPortal VeinCirrhosisLaennec stagingLiverLiver massMetastases

Identifiers

PMID33639984
PMCPMC7913426
OpenAlexW3135255936

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.