P3914 - An Uncommon Phenomenon: Hepatic Metastasis in Breast Cancer

Mohammed A. Khan, MS, DO¹, Shyamal Sheth, DO¹, Rahil Desai, DO², Sana Saleem, MD³, Adnan Ansari, DO⁴, Mishaal Khan, MD⁵, Rida Khan, BS⁶, Lujain Khan, BA⁷, Faizan Khan, MD⁸, Ashirf Al-Ghanoudi, MD, MPH, FACG^8
1Franciscan Health Olympia Fields, Chicago, IL; ²Franciscan Health Olympia Fields, Westlake, OH; ³Franciscan Health, Chicago, IL; ⁴Franciscan Health, Olympia Fields, IL; ⁵Garden City Hospital, Garden City, MI; ⁶Michigan State University College of Human Medicine, East Lansing, MI; ⁷Augustana University, Sioux Falls, SD; ⁸Franciscan Health Olympia Fields, Olympia Fields, IL

Introduction: Breast cancer commonly metastasizes to distant sites such as the lungs, bones, and brain, however, liver metastasis occurs in approximately 3-10% of all cases. The highest incidence of liver metastasis is seen in Luminal A breast cancer, an estrogen-receptor positive (ER+), progesterone-receptor positive (PR+) and HER2- negative subtype. This subtype accounts for ~60% of all breast cancer cases and is associated with a more favorable prognosis and overall survival rates compared to other subtypes. Unique molecular characteristics and the liver’s immune surveillance and detoxification mechanisms contribute to its lower involvement compared to other organs. We present a case of a 69 year old female presenting with liver and bone metastasis secondary to primary metastatic ductal carcinoma.

Case Description/Methods: A 69 year-old female with a medical history of breast cancer s/p lumpectomy who presented with a three-day history of right upper quadrant abdominal pain. She reported experiencing ongoing nausea and weight loss for several months. Imaging revealed numerous hypodense lesions in the liver as well as lytic and sclerotic lesions throughout the spine, suggestive of metastatic disease. Consequently, the patient underwent cytological analysis through endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) of the liver lesions and pathology revealed ER+PR+, HER-2 negative, metastatic ductal carcinoma to liver and bone. Due to the extensive burden of metastasis and impairment of hepatic function leading to visceral crisis, the patient was started on aggressive chemotherapy.

Discussion: The infrequency of liver metastasis in all subtypes of breast cancer, presents a diagnostic and therapeutic conundrum. The delayed detection of liver metastases at advanced stages which are accompanied by substantial disease burden, poses limitations on available treatment options. Emerging literature suggests liver metastasis occurs more commonly in hormone receptor positive (ER+/PR+) and may present synchronously at the same time of the initial breast cancer diagnosis. While symptoms include RUQ pain, jaundice, hepatomegaly, weight loss and general malaise, liver metastasis may be asymptomatic, necessitating the need for imaging and surveillance. Future research should prioritize identifying the interplay between cancer subtypes, the liver microenvironment, and additional metastatic sites to influence treatment decisions and optimize patient outcomes.


Disclosures:


Mohammed A. Khan, MS, DO¹, Shyamal Sheth, DO¹, Rahil Desai, DO², Sana Saleem, MD³, Adnan Ansari, DO⁴, Mishaal Khan, MD⁵, Rida Khan, BS⁶, Lujain Khan, BA⁷, Faizan Khan, MD⁸, Ashirf Al-Ghanoudi, MD, MPH, FACG⁸. P3914 - An Uncommon Phenomenon: Hepatic Metastasis in Breast Cancer, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.