Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer
A 25 year-old woman was diagnosed with invasive ductal adenocarcinoma of the left breast (stage T3N2M0). She was initially treated with neoadjuvant chemotherapy using doxorubicin and cyclophosphamide and received left modified radical mastectomy. She underwent four cycles of adjuvant chemotherapy using the same regimens, and followed by radiation therapy combined with chemotherapy using paclitaxel and hormonal therapy using tamoxifen. After 24 months, the patient developed multiple hepatic lesions that had metastasized from the breast cancer. Blood chemistry revealed the following findings at the time; hemoglobin, 10.9 g/dL; leukocyte count, 3,110/mm3; platelet count, 227,000/mm3; total protein, 8.2 g/dL; albumin 4.3 g/dL; total bilirubin 0.9 mg/dL; AST, 110 IU/L; ALT, 64 IU/L; ALP, 127 IU/L. Tumor analysis revealed a CA15-3 level of 206 U/mL (normal range, 0-28 U/mL). She was immunologically negative for hepatitis B and C viral infection. Combined chemotherapy using docetaxel and cisplatin was initiated. A follow-up CT performed after 2 months revealed the development of hepatomegaly and decreased parenchymal attenuation of the liver suggesting fatty infiltration. Some metastatic lesions in the liver coalesced while others decreased (). A follow-up of the blood chemistry revealed the following: hemoglobin, 8.5 g/dL; leukocyte count, 530/mm3; platelet count, 50,000/mm3; total protein, 5.1 g/dL; albumin 2.7 g/dL; total bilirubin 2.4 mg/dL; AST, 233 IU/L; ALT, 74 IU/L; ALP, 476 IU/L. CA15-3 had increased to 560 U/mL. CT performed after 5 months showed that the liver volume had decreased, while hypertrophy of the left liver was noted. In addition, the hepatic surface had become more lobulated (). On the final follow-up CT performed after 9 months, the shrinkage of the liver was more prominent and perihepatic ascites had developed (). Follow-up blood chemistry showed that the total bilirubin level and hepatic enzymes had decreased (total bilirubin, 1.2 mg/dL; AST, 93 IU/L; ALT, 66 IU/L), and that CA15-3 had also decreased to 140 U/mL. Thereafter, fulminant hepatic failure developed at which time her serum bilirubin level increased to 32.3 mg/dL. She expired a year after initial detection of hepatic metastasis.