"Transparent" Liver

Keywords

Non-alcoholic steatohepatitis; Tamoxifen; Adverse drug reaction; Breast cancer

Clinical Image

A 38-year-old female with estrogen receptor-positive breast cancer came to our hospital for routine evaluation. She had undergone mastectomy 18 months ago and received oral tamoxifen (20 mg/day) as adjuvant endocrine therapy for 17 months. She had no diabetes mellitus, hypertension, hyperlipidemia or HBV/HCV infection history, and no drinking habit. Her body mass index was 22.5, and liver function was normal before tamoxifen therapy. Laboratory tests revealed an elevated alanine aminotransferase (ALT) (72 U/L) and glutamyltransferase (115 U/L) (both normal up to 40 U/L); the cholesterol, triglyceride, and aspartate aminotransferase were within normal range. Unenhanced abdominal computed tomography (CT) scan showed diffused liver parenchymal density reduction and intrahepatic vascular density was relatively high with a liver/spleen ratio of -0.13 (Figure 1A, 1B). A diagnosis of tamoxifenassociated severe non-alcoholic steatohepatitis (NASH) was made, although absence of histopathological confirmation. Tamoxifen was discontinued, and letrozole (2.5mg/day) was prescribed. Her aminotransferase levels returned to normal limits 6 months subsequently. A repeat CT one year later showed hepatic steatosis remission with liver/spleen ratio of 1.0. She continued to receive letrozole and remains well after 12 months of follow-up.

    

    

    Figure 1:  Unenhanced liver computed tomography (CT) scan showed
diffused liver parenchymal density reduction and intrahepatic vascular
density was relatively high with a liver/spleen ratio of -0.13.