Primary hepatocellular carcinoma in a patient with breast carcinoma

We report the case of a patient who presented with a carcinoma of her right breast with ipsilateral axillary lymph node involvement whose staging investigations were otherwise normal. In addition to surgery she received a course of CMF chemotherapy and tamoxifen. Within six months of the diagnosis of breast carcinoma being made, the patient presented as an emergency with widespread intra-abdominal disease from a primary hepatocellular carcinoma. We have not previously witnessed the development of a second primary malignancy in a patient who has already received medication considered to be beneficial in the treatment of both types of malignancy. An extensive literature search has failed to reveal a similar case. The question of immunosuppression secondary to treatment with CMF chemotherapy is raised, and we suggest that perhaps a simple percutaneous biopsy of apparent liver metastases be performed under ultrasound control so as to determine the origin of liver disease in patients with breast carcinoma.