Stage IV luminal B HER2-negative breast cancer with liver-limited metastasis resected after systemic therapy

What happened, in summary

This 42-year-old Javanese woman noticed lumps in her left breast that had been developing over about 1 year and measured around 2 cm. Ultrasound showed a BI-RADS 4 mass in the left breast and a BI-RADS 3 mass in the right breast. Core biopsy of the left breast confirmed invasive carcinoma, classified as luminal B and HER2-negative. She began neoadjuvant chemotherapy with doxorubicin-cyclophosphamide for 3 cycles, followed by modified radical mastectomy. The breast surgery achieved R0 margins. After surgery, treatment continued with paclitaxel every 3 weeks and endocrine suppression using tamoxifen plus Zoladex/goserelin. Additional ultrasound showed the right breast mass was benign BI-RADS 3 and that lymphadenopathy was reactive, but she still received 30 sessions of locoregional radiation. About 1 year later, abdominal MRI showed metastatic liver nodes in segments 7 and 8, measuring 3.7 × 2.7 × 1.6 cm, consistent with liver metastasis from breast cancer. She was referred to hepatobiliary surgery and underwent liver segmentectomy in November 2023. Pathology confirmed metastatic adenocarcinoma, likely from the breast primary. Follow-up MRI showed no remaining liver nodes. She then continued maintenance endocrine therapy with letrozole and goserelin. Her course fits Stage IV breast cancer because of liver metastasis, but the liver disease was treated with curative intent and no remaining liver lesions were seen afterward. She remained fit, well, and disease-free after liver resection while continuing maintenance endocrine therapy. This keeps the breast and liver treatment timeline aligned: systemic therapy controlled the breast cancer, surgery cleared the liver disease, and endocrine suppression continued afterward.