Stage IV luminal A breast cancer: liver resection and disease-free follow-up

What happened, in summary

A 51-year-old Javanese woman was diagnosed in May 2020 with non-special type grade II invasive carcinoma of the left breast. The tumor was described as T2N0M1, luminal A, and HER2-negative, with lung and liver metastases already present. She underwent modified radical mastectomy of the left breast, then completed 6 cycles of adjuvant chemotherapy with docetaxel and continued hormonal therapy. On examination, she had hepatomegaly extending 4 cm below the costal margin but no weight loss, abdominal pain, appetite loss, anemia, jaundice, or lymphadenopathy. An abdominal MRI in August 2020 showed 5 rim-enhanced nodules in liver segments 6, 7, and 8; the largest measured about 2.8 x 2.4 x 2.2 cm in segment 8 and was suspicious for metastasis. After chemotherapy, no extrahepatic disease was seen. She was referred to hepatobiliary surgery and underwent right hepatic segmentectomy. Histology confirmed metastatic adenocarcinoma from the luminal-type invasive breast carcinoma. The resection was successful with R0 margins, meaning no tumor was identified at the surgical margins. A follow-up MRI in May 2021 showed no remaining liver nodules. She continued maintenance hormonal therapy with letrozole and goserelin. After curative-intent liver metastasis resection, she was fit, well, and disease-free. Her course is notable because the liver lesions became surgically manageable after systemic treatment and no extrahepatic disease was seen before liver surgery, despite lung and liver metastases at the original Stage IV diagnosis. The treatment details for this patient are modified radical mastectomy, docetaxel chemotherapy, hormonal therapy, hepatic segmentectomy, and maintenance letrozole plus goserelin.