Metastatic carcinomatous cirrhosis and hepatic hemosiderosis in a patient heterozygous for the H63D genotype

A 38-year-old woman had a mastectomy for infiltrating ductal carcinoma of t he breast 3 years before her last admission and had received chemotherapy f or known liver metastases. She developed the rapid onset of liver failure w ith portal hypertension and died in a hospice. Autopsy revealed macronodula r cirrhosis of the liver secondary to metastatic carcinoma of the breast wi th associated florid fibrosis. This rare lesion, previously called metastat ic carcinomatous cirrhosis, was also found, in this case, to have marked he patic hemosiderosis, and analysis of the patient's DNA showed heterozygosit y for the H63D genotype. The possibility of cirrhosis-associated hemosidero sis secondary to an iron metabolism abnormality associated with the H63D mu tation of the HFE gene is proposed. Computed tomographic scans showed the d evelopment of cirrhosis during the 3-month period before the patient's last admission and suggested the possibility of a postnecrotic type origin.