Characterization of the Syndrome of Acute Liver Failure Caused by Metastases from Breast Carcinoma

Abstract

This review characterizes the clinical presentation and natural history of this syndrome to promote liver biopsy for premortem diagnosis and appropriate therapy.

Acute Liver Failure Caused by Metastatic Breast Cancer: Can We Expect Some Results from Chemotherapy?

“…The general features of the reported case are similar to those reported in literature, and we agree with the author's conclusion to promote liver biopsy for premortem diagnosis and appropriate therapy [2]. In fact, the peculiarity of the reported case was related to the quick response to chemotherapy and the prolonged survival in this particular condition, associated with an improvement in quality of life.…”

“…Hematological malignancies are recognized to be the most common cause of diffuse parenchymal metastases, but this metastatic pattern has also been identified in many primary neoplasms, such as breast cancer [1]. The prognosis is very poor [1][2][3]. Recently, in a literature review performed by Mogrovejo et al [2], 32 cases were characterized (only 25 % were diagnosed premortem, but with a statistically significant trend of increasing premortem diagnosis since 2000: p = 0.001); common signs included jaundice, hepatomegaly, shifting dullness, and bilateral leg edema; mean serum level of AST was 296.4 ± 204.0 U/l, ALT was 183.2 ± 198.9 U/l, and total bilirubin was 8.6 ± 8.3 mg/ dl.…”

“…The prognosis is very poor [1][2][3]. Recently, in a literature review performed by Mogrovejo et al [2], 32 cases were characterized (only 25 % were diagnosed premortem, but with a statistically significant trend of increasing premortem diagnosis since 2000: p = 0.001); common signs included jaundice, hepatomegaly, shifting dullness, and bilateral leg edema; mean serum level of AST was 296.4 ± 204.0 U/l, ALT was 183.2 ± 198.9 U/l, and total bilirubin was 8.6 ± 8.3 mg/ dl. Authors reported also a new case of ALF from breast cancer (mixed ductal and lobular carcinoma) with hepatic metastases (demonstrated by liver biopsy) that occurred 21 years after original breast primary.…”

“…In 2014, we reviewed all 32 reported cases of ALF from hepatic metastases from breast cancer, identified by computerized literature search of articles published since 1950 [2], and found that only one of these patients received chemotherapy after the diagnosis [4]. The other 31 patients were not offered chemotherapy; 24 patients had breast cancer metastatic to the liver only diagnosed by postmortem examination, and the seven other patients were too sick to undergo chemotherapy premortem because of the ALF itself or associated complications, such as esophageal variceal bleeding.…”

Premetastatic niche formation in the liver: emerging mechanisms and mouse models

“…The liver is often not the first site where overt large metastases of the above-mentioned tumours are diagnosed, but it is likely that it harbours micrometastases from early on. These micrometastases become clinically apparent in late stages of these tumours by inducing jaundice, abdominal pain, or ascites and are also considered as direct cause of death by destroying the vital function of this organ in colorectal carcinoma [15] or breast carcinoma [16,17].…”