2379 Biopsy Confirmed Infiltrating Breast Cancer in the Liver Not Captured by MRI Abdomen

Abstract

INTRODUCTION: Early detection of liver metastases (mets) has the potential to improve patient outcomes, and those with breast cancer are at increased risk for liver mets. Literature has shown that computed tomography (CT) or magnetic resonance imaging (MRI) techniques detect most liver mets with a high level of accuracy; however, small mets or non-mass mets in sinusoidal spaces, are less likely to be recognized on imaging studies. Of the imaging studies available, MRI is toted to be more sensitive than CT or positron emission tomography in detecting small lesions. Here we present a case of metastatic breast cancer not detected by MRI. CASE DESCRIPTION/METHODS: A 50-year-old female with a history of cirrhosis, invasive lobular carcinoma of the left breast (T3N3aM1) following unilateral mastectomy and axillary dissection, and mets to uterus status post total abdominal hysterectomy with bilateral salpingo-oophorectomy presented with complaints of confusion and abdominal distension. She was admitted for acute on chronic decompensated liver failure with exam significant for jaundice, asterixis, distended abdomen, and pitting edema to bilateral extremities. MELD score on admission was 23 with Child-Pugh Class C, and labs were notable for hyperbilirubinemia (15.9) and elevated alkaline phosphatase (950). Abdominal ultrasound demonstrated a nodular heterogenous liver consistent with cirrhosis. Ascitic fluid was felt to be secondary to portal hypertension (SAAG 2.4g/dL, ascitic protein 0.5 g/dL) and negative for spontaneous bacterial peritonitis. The patient was negative for hepatitis A, B, C, or D, antimitochondrial antibodies, and acetaminophen levels were unremarkable. MRI of the abdomen indicated hypertrophy of the left lobe of the liver and an irregular hepatic capsule contour, but no distinct reticular enhancement pattern or focal abnormalities. Transjugular liver biopsy was, however, positive for a large burden of metastatic lobular breast carcinoma, mostly confined to sinusoidal spaces, in a background of end-stage liver disease and acute cholestasis. DISCUSSION: The presence of liver mets that were undetectable by MRI, the imaging technique of choice metastatic lesions, demonstrates this case’s uniqueness. The size and/or location of the metastasis is directly related to the ability of anatomic imaging to detect metastatic lesions. This patient’s presentation and lack of radiographic evidence of metastasis demonstrates the importance of tissue pathology studies in patients with suspected metastatic processes.