A case of advanced breast cancer associated with development of liver atrophy with progressive liver failure during treatment.

A 44-year-old-female came to our hospital with abdominal distension in April 2005. She had been diagnosed with breast cancer in 1991, which was treated with mastectomy, postoperative radiation therapy,and a five-year course of hormonal therapy. An abdominal computed tomography (CT) scan revealed multiple hypoattenuated lesions in both lobes of her liver, which were diagnosed as metastatic breast cancer by liver biopsy. Weekly chemotherapy with paclitaxel was initiated on May 13. Trastuzumab and tamoxifen were added after two weeks. After six months of treatment, the CT scans showed reductions in the size of her multiple liver metastases along with the development of slight irregularities in the liver surface. Liver dysfunction was improved,and tumor marker BCA225 levels significantly decreased. After ten months of treatment, the CT scan showed nodular irregularity of the hepatic borders with deformation and atrophic changes. After twelve months of treatment,she was readmitted with abdominal distension and lower extremity edema. Increased ascites and appearance of esophageal varices were observed. Laboratory values were compatible with decompensation of liver function,although BCA225 levels still remained low. Despite discontinuation of chemotherapy and hormonal therapy at this time, she died from liver failure less than two weeks later. The atrophic changes and liver failure are suspected to have resulted from the chemotherapy and/or hormonal therapy.