PMC9035873_01
(A-D) IHC of the tissue of excisional biopsy of the right breast in 2012 [x200, (A) IHC for ER, (B) IHC for PR, (C) IHC for HER2, and (D) IHC for Ki-67]. (E-H) IHC of the tissue of liver biopsy in 2017 [x200, (E) IHC for ER, (F) IHC for PR, (G) IHC for HER2, and (H) IHC for Ki-67].
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Immunohistochemistry (IHC) detected estrogen receptor (ER) (35%+), progesterone receptor (PR) (75%+), human epidermal growth factor receptor 2 (HER2) (intraduct: 3+), and Ki-67 (25%+) ( Figures 1A-D ). The pathological examination after liver biopsy on 7 June 2017, confirmed metastatic breast carcinoma; IHC detected ER (90%+), PR (75%+), HER2 (1+), Ki-67 (about 30%+), FISH (non-amplification) ( Figures 1E-H ), CK7 (+), E-cadherin (+), GATA-3 (+), hepatocyte (-), CD3 (vessel+), GCDFP15 (+), and mammaglobin (+), with the diagnosis of right breast cancer recurrence (rT0N0M1, stage IV, lung and liver metastases).
On 2 May 2017, CT showed a pulmonary metastasis with a long diameter of 1.3 cm (A). On 31 May 2017, CT showed a hepatic metastasis with a long diameter of 4.7 cm on the right anterior lobe (B). On 30 October 2017, CT showed a hepatic metastasis with a long diameter of 2.0 cm before involved in a clinical trial of adjuvant endocrine therapy on the right anterior lobe (C). On 30 August 2019, CT showed no apparent hepatic metastasis (D). On 21 November 2019, CT showed a hepatic metastasis with a long diameter of 1.8 cm on the right anterior lobe (unclear boundary) (E). On 25 November 2019, MRI showed a hepatic metastasis with a long diameter of 1.2 cm on the right anterior lobe (F). On 15 June 2020, CT showed a hepatic metastasis with a long diameter of 1.5 cm on the right anterior lobe (G), and MRI showed hepatic metastases, especially the biggest one with a long diameter of 2.7 cm on the right anterior lobe (H). On 11 December 2020, CT showed a hepatic metastasis with a long diameter of 3.2 cm on the right anterior lobe (I), and MRI showed a hepatic metastasis with a long diameter of 3.6 cm on the right anterior lobe (J). On 26 February 2021, CT showed a hepatic metastasis with a long diameter of 3.2 cm on the right anterior lobe (K), and MRI showed a hepatic metastasis with a long diameter of 4.4 cm on the right anterior lobe (L). On 21 April 2021, CT showed a hepatic metastasis with a long diameter of 5.6 cm on the right anterior lobe (M), and MRI showed a hepatic metastasis with a long diameter of 6.0 cm on the right anterior lobe (N). On 6 August 2021, MRI showed a hepatic metastasis with a long diameter of 5.0 cm on the right anterior lobe (O). On 9 October 2021, MRI showed a hepatic metastasis with a long diameter of 3.5 cm on the right anterior lobe (P), a hepatic metastasis with a long diameter of 1.0 cm on the right posterior lobe (Q), and a hepatic metastasis with a long diameter of 1 cm on the left lateral lobe (R). On 21 October 2021, the last CT showed a pulmonary metastasis with a long diameter of 1.0 cm (S). On 15 December 2021, MRI showed a hepatic metastasis with a long diameter of 6.7 cm on the right anterior lobe (T), a hepatic metastasis with a long diameter of 1.0 cm on the right posterior lobe (U), and a hepatic metastasis with a long diameter of 1 cm on the left lateral lobe (V).
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CT of the lung revealed multiple nodules in both lungs ( Figure 2A ), and abdominal ultrasound exhibited space-occupying lesions in the right anterior and posterior segments of the liver, which were confirmed by CT ( Figure 2B ). CT on 21 November 2019, and on MRI on 25 November 2019, compared with the last evaluation ( Figures 2C-F ). CT of the lung did not show any progression of the pulmonary metastatic foci. However, on 15 June 2020, liver lesion progression was confirmed by abdominal CT and MRI of the liver ( Figures 2G, H ). On 11 December 2020, the evaluation revealed that the liver lesion was slightly larger than before based on abdominal CT and MRI of the liver ( Figures 2I, J ), and then the treatment was changed to letrozole and chidamide. Imaging showed that the liver lesion was larger than before on 26 February 2021 ( Figures 2K, L ), and eribulin monotherapy was administered on 11 March 2021. After 2 months, drug resistance developed, and abdominal computed tomography and MRI were performed ( Figures 2M, N ). On 6 August 2021, an MRI of the liver revealed a space-occupying lesion on the upper segment of the right anterior lobe (range: 5.0 x 2.6 cm,  Figure 2O ). On 9 October 2021, an MRI of the liver showed that the lesion in the upper segment of the right anterior lobe of the liver was smaller than before, but new lesions were identified in the right posterior and left lateral lobes of the liver ( Figures 2P-R ). October 2021, the last CT scan of the lung showed that the lesions had apparently reduced ( Figure 2S ). On 15 December 2021, the last MRI of the liver showed that the range of the lesion on the right anterior lobe of the liver was larger, and perilesional enhancement on the right posterior and left lateral lobes of the liver was more obvious ( Figures 2T-V ). Overall, the metastatic focus of the lung was smaller, but there was a progression of liver metastasis ( Figure 3 ).
Timeline of the patient's disease progression.
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On 15 December 2021, the last MRI of the liver showed that the range of the lesion on the right anterior lobe of the liver was larger, and perilesional enhancement on the right posterior and left lateral lobes of the liver was more obvious ( Figures 2T-V ). Overall, the metastatic focus of the lung was smaller, but there was a progression of liver metastasis ( Figure 3 ).