Metastatic Breast Cancer Causing Bile Duct Obstruction and Liver Failure

What happened, in summary

A 39-year-old woman came to the hospital with a week of poor appetite and fatigue. Two years earlier, she had been diagnosed with Stage II right breast cancer described as scirrhous carcinoma with axillary lymph-node involvement. She received chemotherapy before surgery and then underwent breast surgery. Afterward, the cancer recurred with multiple bone and liver metastases, and she was treated with paclitaxel and bevacizumab. At the new admission, she had jaundice and markedly abnormal liver tests. Imaging showed that the known liver metastases had increased in both number and size, with diffuse abnormal changes in the liver and narrowing of the bile ducts. Endoscopic testing found extensive bile-duct obstruction. A biopsy from the common bile duct showed tumor cells consistent with her breast cancer; the metastatic cells were estrogen-receptor negative, progesterone-receptor negative, and HER2-negative. A plastic stent was placed to drain the right intrahepatic bile duct, which briefly lowered her bilirubin level and improved symptoms. The disease nevertheless progressed quickly. Diffuse liver involvement and direct invasion of the bile duct led to worsening liver failure, and she died 28 days after hospital admission. Her course reflects a rare pattern of breast-cancer spread in which diffuse liver metastases extended into the common bile duct and caused severe obstructive jaundice.