Primary hepatocellular carcinoma in a patient with history of treated breast cancer: a case report with challenging diagnosis and treatment

Christoforos Kosmidis,1 Nikolaos Varsamis,1 Georgios Anthimidis,1 Sofia Baka,2 Dimitrios Valoukas,3 Triantafyllia Koletsa,4 Katerina Zarampouka,4 Georgios Koimtzis,5 Eleni Georgakoudi,6 Paul Zarogoulidis,7 Christoforos Efthymiadis1 1Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece; 2Department of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece; 3Department of Oncology, General Hospital of Ptolemaida, Ptolemaida, Greece; 4Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; 5Third Surgical Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; 6Aristotle University of Thessaloniki, Thessaloniki, Greece; 7Pulmonary-Oncology Unit, “Theageneio” Cancer Hospital, Thessaloniki, Greece Introduction: Breast cancer is the most common malignancy in women worldwide. Long-term survivors among patients treated for breast cancer are at a high risk for developing a second primary malignancy. Hepatocellular carcinoma is the most frequent primary hepatic malignancy and should be ruled out in breast cancer patients who are diagnosed with solitary hepatic lesions. False diagnosis may lead to inappropriate oncologic staging and treatment of the disease. Case presentation: We present the case of a 73-year-old female patient who had been treated for invasive ductal breast cancer 7 years ago and was diagnosed with a solid hepatic lesion at segments VI and VII and a small, calcified lesion at the tail of the pancreas on follow-up with an abdominal computed tomography. Oncology council decided that both lesions could be resected after determining whether they were metastatic or second primary malignancies. The patient underwent laparotomy and rapid biopsy which showed primary hepatocellular carcinoma and fibrosis of the pancreas. We performed hepatic segmentectomy (VI–VII) and cholecystectomy, while the pancreatic lesion was left intact. The postoperative course of the patient was uncomplicated and she remains disease free 2 years after the operation without any adjuvant therapy. Conclusion: All hepatic lesions detected in breast cancer patients should be evaluated with open mind and liver biopsy should be performed to get a definitive diagnosis and implement the proper treatment strategy. Keywords: breast cancer, hepatocellular cancer, second primary malignancy, rapid biopsy, microwave tissue coagulator