LATE LIVER METASTASIS 20 YEARS AFTER THE INITIAL DIAGNOSIS: A CASE REPORT OF METACHRONOUS HORMONE DEPENDENT TUMORS OF BREAST AND ENDOMETRIUM

Abstract

Breast cancer is the most common cancer and a significant cause of morbidity and mortality in female population worldwide. The liver is the third most common metastatic site for invasive breast malignancy besides bones, lungs and brain. Breast cancer has been linked with metachronous bone, endometrial, colon/rectal, connective tissue (sarcoma), leukemia, lung, ovary or thyroid cancer. Studies have shown an increased risk of secondary malignancies in women treated for breast malignancy in connection to adjuvant treatment in certain cases.

We present a case of a 71 year old woman who was diagnosed with breast cancer 20 years ago. The primary diagnosis was invasive lobular breast cancer localized in left lower lateral quadrant. Micromorphological, histochemical and immunohistochemical analyses rendered diagnosis inconclusive due to lack of tissue so after 4 months rebiopsy was performed. Clinico-pathological correlation of the second biopsy was in favor of liver metastasis of partially hormone dependent breast cancer. Immunohistochemistry was vital for the diagnosis on the liver biopsy, in particular GATA3 positivity and vimentin negative staining which helped us exclude endometrial cancer metastasis which was diagnosed before the initial liver biopsy. GATA 3(+)/vimentin(-) panel proved to be superior to GCDFP-15 and mammaglobin in proving the breast origin of  the secondary tumor deposit.

Liver metastasis from primary breast cancer can in certain cases occur many years after the initial diagnosis which shows the importance and necessity for long term follow-up of these patients, while considering the possibility of metachronous tumors as well.