• Sophie E Aapkes, Lucas H P Bernts, M van den Berg, Ron T Gansevoort, and DrenthJoost P HJPHDepartment Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands..
• Department Nephrology, University Medical Center, Groningen, The Netherlands.
• Medicine (Baltimore). 2021 Aug 13; 100 (32): e26797e26797.

RationalePolycystic liver disease is a rare disease characterized by the growth of numerous cysts in the liver. The liver function remains well preserved, but liver volumes can grow very large, and some patients ultimately need a liver transplantation. Other treatment options are limited and there is an unmet need for new therapeutic options.Patient ConcernsWe describe a 59-year-old patient with pain in the abdomen, especially when bending forward. Five years ago, she was diagnosed with breast cancer and as an incidental finding a couple of large liver cysts were diagnosed, explaining her abdominal pain.DiagnosisPolycystic liver disease with several large liver cysts.InterventionsThe patient was treated with tamoxifen, an estrogen receptor modulator, as treatment for her hormone receptor positive breast cancer. One of the liver cysts was aspirated.OutcomesIn the 4.6 years after the start of tamoxifen treatment, 20 mg once daily, the volume of her liver cysts decreased remarkably. There was a reduction of combined cyst volume from 311 mL to 22 mL without percutaneous drainage.LessonsEpidemiological as well as experimental evidence supports a pivotal role for estrogens as a driver for growth of polycystic livers. Estrogen antagonism has often been proposed as a therapeutic target, but supporting evidence is lacking in the literature. We hypothesize that the decrease in cyst size in this patient was caused by tamoxifen therapy, suggesting an in vivo antagonistic effect on cystic cholangiocytes. This is an important finding because tamoxifen could be a promising new treatment option for polycystic liver disease.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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