Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer
A 53 year-old woman visited the emergency department at our institution complaining of back pain. On physical examination, a palpable mass in the right breast was found. There were also signs of jaundice, abdominal distension, and hepatomegaly. After further examination including abdominal CT and breast ultrasonography, she was diagnosed to have multiple liver and bone metastases from breast cancer. The breast mass was proven to be an invasive ductal adenocarcinoma by biopsy. Initial abdominal CT scan showed hepatomegaly and decreased attenuation of the liver parenchyma as well as multiple hepatic metastases in both lobes. The contour of the liver was mildly lobulated and a small amount of ascites was also noted in the perihepatic space. In addition, thrombosis of bilateral intrahepatic portal veins was also seen (). The patient was treated for her malignancy by combined chemotherapy using paclitaxel and trastuzumab for palliation. Blood chemistry revealed the following findings; hemoglobin, 15.0 g/dL; leukocyte count, 11,500/mm3; platelet count, 214,000/mm3; total protein, 5.8 g/dL; albumin 3.1 g/dL; total bilirubin 4.3 mg/dL; aspartate aminotransferase (AST), 82 IU/L; alanine aminotransferase (ALT), 385 IU/L; alkaline phosphatase (ALP), 600 IU/L; gamma-glutamyl transpeptidase (GGT), 1,152 IU/mL. Immunologic tests showed no evidence of hepatitis B or C viral infection. Assessment of her tumor markers revealed carcinoembryonic antigen (CEA) to be 680.82 ng/mL and serum carbohydrate associated antigen (CA) 19-9 to be 17,960 U/mL (normal range, 0-37 U/mL).\nAfter six cycles of chemotherapy, a follow-up CT scan was performed. It showed decreased hepatic volume and enlargement of the caudate lobe. The metastatic lesions in the liver either decreased in size or coalesced with one another and portal vein thrombosis was seen to resolve. The hepatic surface also became more lobulated (). The results of a follow-up of the blood chemistry was as follows: hemoglobin, 9.4 g/dL; leukocyte count, 8,100/mm3; platelet count, 146,000/mm3; total protein, 4.4 g/dL; albumin 2.7 g/dL; total bilirubin 1.5 mg/dL; AST, 43 IU/L; ALT, 14 IU/L; ALP, 180 IU/L; GGT, 98 IU/mL; prothrombin time of 87% and international normalized ratio (INR), 1.09. CEA level had decreased to 6.10 ng/mL. However, a metastatic lesion was subsequently discovered in the cerebellum for which she underwent radiation therapy and palliative chemotherapy consisting of doxorubicin and cyclophosphamide. On the follow-up CT performed after 7 months, shrinkage of liver volume and surface nodularity were more prominent. The amount of perihepatic ascites also increased compared with the previous CT scan ().\nFinally, she expired due to multi-organ failure and worsening metastasis 17 months after initial hospitalization.