Tamoxifen-associated liver hematoma in early-stage breast cancer: a case report

A 44-year-old African American female with a previous medical history of major depressive disorder presented to the hospital with a dense feeling on her right breast following self-examination. Pathology report after right breast lumpectomy revealed the diagnosis of invasive ductal carcinoma (ER+, PR+ and HER2-) of the right breast. Nine months after the diagnosis, a combination of local radiotherapy with chemotherapy with tamoxifen (20 mg tablet/day) was started. Two months post tamoxifen initiation, the patient presented at the hospital with right upper quadrant abdominal pain with sharp and stabbing characteristics, radiating to the right shoulder. Abdominal/pelvic CT with contrast revealed that the patient developed a 25×58×85 mm subcapsular hematoma of the right anterior lobe of the liver. Our case suggests the development of liver hematoma with thrombocytopenia associated with tamoxifen therapy. Following tamoxifen administration, there was a significant drop in the platelet count from 139×109 /L to 69×109/L between day 1 and day 3 in our patient. Tamoxifen either alone or given concurrently with chemotherapy may increase the risk of thrombosis. Our patient presented with clumps on day 2. Even though our patient experienced liver hematoma on tamoxifen, studies have shown that the concurrent use of tamoxifen with direct anticoagulants showed a similar risk compared with aromatase inhibitors.