Phenotype of acute liver failure in inapparent small cell lung cancer

Czech version

Authors: Faktorová X. ¹; Staškovanová T. ¹; Bilíková K. ¹; Hokša R. ²; Tvrdík T. ³; Ďurkovičová Z. ¹; Szántová M. ¹
Authors‘ workplace: III. interná klinika LF UK a UN Bratislava, Slovenská republika 2 Ústav patologickej anatómie LF UK a UN Bratislava, Slovenská republika 3 I. rádiologická klinika LF UK, SZU a UN Bratislava, Slovenská republika ¹
Published in: Gastroent Hepatol 2020; 74(5): 404-409
Category: Gastrointestinal Oncology: Case Report

Overview

Acute liver failure is defined by the manifestation of liver failure from 7^th to 21^st day in a previously healthy liver. The most frequent causes are viral hepatitis B, A, E, drug or toxin-induced hepatotoxicity (Amanita phalloides), rarely Wilson’s disease, autoimmune hepatitis, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, or vascular causes (Budd-Chiari syndrome, hypoxic hepatitis). We present a 71-year- -old female patient with metabolic syndrome admitted to hospital with cholestasis, progression of weakness, abdominal pain, and breathlessness. Because of suspected pleuropneumonia, the treatment with ceftriaxone/metronidazole was initiated. Due to cholestasis progression and suspicion of drug-induced liver toxicity, the treatment was stopped on 5^th day. Imaging methods (ultrasonography, CT, magnetic resonance imaging) found multiple small liver lesions, suspected metastatic involvement, which was not confirmed by positron emission tomography – computed tomography. Due to the rapid progression of the patient’s condition with the onset of icterus, ascites, encephalopathy, a liver biopsy was not done. The patient died on the 17^th day of hospitalization. The primary tumour was not detected during her life, and not by pathological section. The diffuse metastasis of small cell lung cancer (SCLC) in the liver was found by histological post mortem examination. The case report suggests high invasiveness of SCLC with a possibility of unusual manifestation in a form of acute hepatic failure.

Keywords:

acute liver failure – small cell lung cancer – hepatotoxicity – diffuse metastasis

Sources

1. European Association for the Study of the Liver, Clinical practice guidelines panel, Wendon J et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66 (5): 1047–1081. doi: 10.1016/j.jhep.2016.12.003.

2. Kohútek F, Bystrický B, Tamášová M. Liečba iniciálne metastatického malobunkového karcinómu pľúc. Onkológia (Bratislava) 2013; 8 (5): 303–306.

3. Mishima S, Nozaki Y, Mikami S et al. Diffuse liver metastatis of small-cell lung cancer presenting as acute liver failure and diagnosed by transjugular liver biopsy: a rare case in whom nodular lesions were detected by enhanced CT examination. Case Rep Gastroenterol 2015; 9 (1): 81–87. doi: 10.1159/000381 140.

4. Guerriero M, Carbone A, Colusurdo F et al. Sudden onset acute liver failure in a patient with clinically occult small cell lung carcinoma: autopsy report and review of the medical literature. Autops Case Rep 2019; 9 (2): e2019089. doi: 10.4322/acr.2019.089.

5. Elliott JA, Osterlind K, Hirsch FR et al. Metastatic patterns in small-cell lung cancer: correlation of autopsy findings with clinical parameters in 537 patients. J Clin Oncol 1987; 5 (2): 246–254. doi: 10.1200/JCO.1987.5.2.246.

6. Ihara N, Yashiro N, Kinoshita T et al. Diffuse intrasinusoidal liver metastasis of small cell lung cancer causing fulminant hepatic failure: CT findings – a case report. Radiat Med 2001; 19 (5): 275–277.

7. Sato K, Takeyama Y, Tanaka T et al. Fulminant hepatic failure and hepatomegaly caused by diffuse liver metastasis from small cell lung carcinoma: 2 autopsy cases. Respir Investig 2013; 51 (2): 98–102. doi: 10.1016/j.resinv.2012.12.004.

8. Athanasakis E, Mouloudi E, Prinianakis G et al. Metastatic liver disease and fulminant hepatic failure: presentation of a case and review of the literature. Eur J Gastroenterol Hepatol 2003; 15 (11): 1235– –1240. doi: 10.1097/00042737-200311000-00014.

9. Krauss EA, Ludwig PW, Sumner HW. Metastatic carcinoma presenting as fulminant hepatic failure. Am J Gastroenterol 1979; 72 (6): 651–654.

10. McGuire BM, Cherwitz DL, Rabe KM et al. Small-cell carcinoma of the lung manifesting as acute hepatic failure. Mayo Clin Proc 1997; 72 (2): 133–139. doi: 10.4065/72.2.133.

11. Kaira K, Takise A, Watanabe R et al. Fulminant hepatic failure resulting from small-cell lung cancer and dramatic response of chemotherapy. World J Gastroenterol 2006; 12 (15): 2466–2468. doi: 10.3748/wjg.v12.i15.2466.

12. Gilbert J, Rutledge H, Koch A. Diffuse malignant infiltration of the liver manifesting as a case of acute liver failure. Nat Clin Pract Gastroenterol Hepatol 2008; 5 (7): 405–408. doi: 10.1038/ncpgasthep1154.

13. Vaideeswar P, Munot S, Rojekar A et al. Hepatic diffuse intra-sinusoidal metastases of pulmonary small-cell carcinoma. J Postgrad Med 2012; 58 (3): 230–231. doi: 10.4103/0022-3859.101654.

14. Lo AA, Lo EC, Li H et al. Unique morphologic and clinical features of liver predominant/primary small cell carcinoma – autopsy and biopsy case series. Ann Diagn Pathol 2014; 18 (3): 151–156. doi: 10.1016/j.anndiagpath.2014.02.007.

15. Kaman L, Iqbal J, Pallet M et al. Primary small cell carcinoma of liver: a rare tumor. Gastroenterology Res 2010; 3 (4): 180–184. doi: 10.4021/gr2010.06.215w.

16. Jo JM, Cho YK, Hyun CL et al. Small cell carcinoma of the liver and biliary tract without jaundice. World J Gastroenterol 2013; 19 (44): 8146–8150. doi: 10.3748/wjg.v19.i44.8146.