Tamoxifen is an important anti-estrogen agent used for the treatment of hormone receptor-positive breast cancer and it may induce reversible hepatic steatosis. This is usually transient and may occasionally be associated with hepatic dysfunction. It only rarely leads to cirrhosis 1.
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Epidemiology
45% of the patients having adjuvant tamoxifen develop hepatic steatosis in the first two years. The steatosis is usually mild in severity.
Pathology
The mechanism by which tamoxifen causes hepatic steatosis is not fully understood. In vivo research shows that the drug disrupts plasma and liver lipid metabolism 3.
The distribution of fat in the liver in this entity is right-lobe dominant. This may be due to the higher content of medium-chain fatty acids and glucose and the absorbed content of tamoxifen in the superior mesenteric venous blood, which is directed predominantly towards the right lobe (streamline flow) 2.
Radiographic features
- decreased liver-spleen ratio during therapy, and an increase in the ratio after therapy
- mild hepatomegaly
Treatment and prognosis
The mean time for the tamoxifen-induced hepatic steatosis to resolve after therapy has ended is 12-18 months. Rarely the steatosis progresses to overt cirrhosis.
Differential diagnosis
- hepatic metastases
- non-tamoxifen induced hepatic steatosis