Primary hepatocellular carcinoma in a patient with history of treated breast cancer: a case report with challenging diagnosis and treatment

• Published in: International journal of general medicine Vol. 11; pp. 399 - 403
• Main Authors: Kosmidis, Christoforos, Varsamis, Nikolaos, Anthimidis, Georgios, Baka, Sofia, Valoukas, Dimitrios, Koletsa, Triantafyllia, Zarampouka, Katerina, Koimtzis, Georgios, Georgakoudi, Eleni, Zarogoulidis, Paul, Efthymiadis, Christoforos
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2018; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Abdomen; Adjuvant chemotherapy; Biopsy; Breast cancer; Calcification; Cancer diagnosis; Cancer metastasis; Cancer patients; Cancer therapies; Carcinoma; Care and treatment; Case Report; Case reports; CAT scans; Chemotherapy; Diagnostic imaging; Family medical history; Fibrosis; Health aspects; hepatocellular cancer; Hepatocellular carcinoma; Laparotomy; Liver; Liver cancer; Lymphatic system; Medical prognosis; Metastasis; microwave tissue coagulator; Oncology; Pancreas; Patients; Radiation therapy; rapid biopsy; second primary malignancy; Sorafenib; Surgery; Tomography; Type 2 diabetes; Ultrasonic imaging; Greece; microwave tissue coagulator; rapid biopsy; breast cancer; second primary malignancy; hepatocellular cancer
• ISSN: 1178-7074; 1178-7074
• DOI: 10.2147/IJGM.S176052

Breast cancer is the most common malignancy in women worldwide. Long-term survivors among patients treated for breast cancer are at a high risk for developing a second primary malignancy. Hepatocellular carcinoma is the most frequent primary hepatic malignancy and should be ruled out in breast cancer patients who are diagnosed with solitary hepatic lesions. False diagnosis may lead to inappropriate oncologic staging and treatment of the disease.
We present the case of a 73-year-old female patient who had been treated for invasive ductal breast cancer 7 years ago and was diagnosed with a solid hepatic lesion at segments VI and VII and a small, calcified lesion at the tail of the pancreas on follow-up with an abdominal computed tomography. Oncology council decided that both lesions could be resected after determining whether they were metastatic or second primary malignancies. The patient underwent laparotomy and rapid biopsy which showed primary hepatocellular carcinoma and fibrosis of the pancreas. We performed hepatic segmentectomy (VI-VII) and cholecystectomy, while the pancreatic lesion was left intact. The postoperative course of the patient was uncomplicated and she remains disease free 2 years after the operation without any adjuvant therapy.
All hepatic lesions detected in breast cancer patients should be evaluated with open mind and liver biopsy should be performed to get a definitive diagnosis and implement the proper treatment strategy.