Breast Cancer Recurrence in the Liver Mimicking Cirrhosis

What happened, in summary

A 63-year-old woman developed progressive abdominal swelling, abnormal liver tests, and shortness of breath 14 years after treatment for left breast cancer. Her original tumor was T2 G2 N1, HER2-negative, and progesterone-receptor positive. Seven of 21 lymph nodes had contained cancer. She had completed four cycles of neoadjuvant FEC-T, mastectomy with axillary clearance, and five years of hormone therapy, beginning with tamoxifen and changing to anastrozole after menopause. She was later discharged from follow-up with no evidence of recurrence.

At presentation, examination showed ascites and a firm right-upper-abdominal mass. Ultrasound and cross-sectional imaging showed a shrunken, irregular liver with numerous lesions, marked ascites, a large left pleural effusion, two right-lung lesions, and sclerotic vertebral lesions. The appearance initially suggested cirrhosis with multifocal primary liver cancer. Therapeutic paracentesis was performed while the diagnosis was investigated.

Liver biopsy instead showed ER-positive metastatic breast carcinoma without established cirrhosis, confirming recurrent breast cancer with pseudocirrhosis. Only the biopsy-confirmed liver involvement is recorded as a metastatic site. Endocrine therapy was restarted, but her condition deteriorated quickly. Refractory hydropneumothorax required video-assisted thoracoscopic pleurodesis, and she died from hepatorenal syndrome five weeks after the initial presentation. The case shows how extensive breast-cancer deposits can mimic cirrhosis and produce severe portal-hypertension complications after a long disease-free interval.