Primary or metastatic hepatic carcinoma? A breast cancer patient after adjuvant chemotherapy and radiotherapy postoperatively with intrahepatic cholangiocarcinoma and review of the literature

Abstract

Background: The liver is a common site of metastases, followed by the bone and lung in breast cancer. The symptoms of hepatic metastases are similar to intrahepatic cholangiocarcinoma (ICC). ICC is rare, with an overall incidence rate of 0.95 cases per 100,000 adults. The incidence of ICC for patients with breast cancer is very uncommon. Breast cancer patient with ICC is easily misdiagnosed as hepatic metastases.

Case presentation: We report a breast cancer patient postoperatively who was hospitalized because of having continuous irregular fever for 1 month. Antibiotics were given for 1 week without any significant effect. Her admission bloods revealed elevated levels of carcino-embryonic antigen. Magnetic resonance imaging diagnosis showed multiple liver metastases. We believed that the woman had hepatic metastases until biopsy guided by computed tomography. The liver biopsy pathology analysis considered the possibility of primary intrahepatic cholangiocarcinoma.

Conclusions: Breast cancer patient with space-occupying lesions in the liver is easily considered to be progressed hepatic metastases. Image-guided biopsy is the best diagnostic method for breast cancer with liver mass to avoid misdiagnosis and classify the molecular subtypes to make appropriate treatment.

Keywords: Breast neoplasm; Intrahepatic cholangiocarcinoma; Liver metastases.

Fig. 1

Photomicrographs of invasive breast carcinoma. a Light microscopy sections with hematoxylin and eosin staining demonstrating markedly atypical endothelial cells (HE, ×200). b The chief cells showed positive staining to CD10 (IHC, ×100)

Fig. 2

Liver magnetic resonance image (MRI) after the patient have continued irregular fever for 1 month

Fig. 3

Photomicrographs of intrahepatic cholangiocarcinoma. a Eosin staining demonstrating markedly atypical cells (HE × 200). b CK7,cytoplasm + (IHC, ×200). c CK19,cytoplasm + (IHC, ×200)