Metastatic Prostatic Carcinoma Presenting as Fulminant Hepatic Failure

Shakir, Faiz; Madhoun, Mohammed; Whorton, Joshua; Harty, Richard F.

doi:10.1097/smj.0b013e31817c74c3

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…Radiologically occult liver metastasis usually occurs as diffuse malignant infiltration of the liver. This has been reported in the literature secondary to metastases from breast and lung carcinomas, prostate and urothelial carciomas, carcinomas of unknown primary origin and hematologic malignancies such as Hodgkin and Non-Hodgkin lymphomas [11][12][13][14][15][16]. USG and CT scans of the liver were reported as normal in almost all of these reported cases as it was in our case.…”

Section: Discussionsupporting

confidence: 75%

Asymptomatic persistent non-virus non-alcohol related elevation of aminotransferase levels: a rare case and review of the literature

Tazegül¹,

Gunes²,

Akın³

et al. 2017

MMJ

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Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are found in the liver in their highest concentrations. Two most common causes of asymptomatic transaminase elevation are viral infections and alcohol intake. Persistent non-viral nonalcohol related elevation of aminotransferases indicates that one or both aminotransferase levels exceed the upper reference limit for a period of at least 4 weeks. Causes are classified as hepatic; such as steatosis, autoimmune hepatitis, Wilson's disease, hemachromatosis, and nonhepatic; such as celiac disease, myopathy and hyperthyroidism. Drug use and substance abuse may also cause an increase in aminotransferase levels. Here, we report a fifty-eight-year old female patient who had asymptomatic non-viral non-alcohol related aminotransferase elevation for a year incidentally diagnosed with malignant infiltration of the liver. It should be noted that, malignant infiltration of the liver may also be a rare cause of asymptomatic persistent elevation of transaminases. Such cases, especially with suspected malignancy should be evaluated in terms of this condition. Keywords: Aspartate aminotransferase, Alanine aminotransferase, Asymptomatic diseases, Incidental findings ÖZAlanin aminotransferaz (ALT) ve aspartat aminotransferaz (AST) en yüksek konsantrasyonlarda karaciğerde bulunur. Asemptomatik transaminaz yüksekliğinin en sık iki sebebi viral enfeksiyonlar ve alkol kullanımıdır. Virüs ve alkol ilişkisi olmadan persistan aminotransferans yüksekliği, tanımlanır. Bu yüksekliğe, steatoz, otoimmün hepatit, Wilson hastalığı, hemokromatoz gibi hepatik kaynaklı nedenler ve çölyak hastalığı, miyopati ve hipertiroidizm gibi hepatik olmayan nedenler sebep olabilir. İlaç kullanımı ve uyuşturucu madde kullanımı da aminotransferaz yüksekliğine sebep olabilir. Bu vakada elli sekiz yaşında kadın bir hasta sunmaktayız. Hastanın non-virüs non-alkol sebepli 1 yıl süren aminotransferaz yüksekliği mevcut olup hasta insidental olarak malin karaciğer infiltrasyonu tanısı almıştır. Karaciğerin malin infiltrasyonunun da persistan asemptomatik transaminaz yüksekliğine sebep olabileceği unutulmamalıdır. Bu tarz hastalarda, özellikle malinite şüphesi olan vakalar bu yönden de değerlendirilmelidir.

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Section: Discussionsupporting

confidence: 75%

Asymptomatic persistent non-virus non-alcohol related elevation of aminotransferase levels: a rare case and review of the literature

Tazegül¹,

Gunes²,

Akın³

et al. 2017

MMJ

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“…In severe cases with rapidly growing tumors, patients can present with FHF and subsequent multisystem organ failure as a result of homogenous infiltration of the liver by metastatic disease. Shakir [16] presented a case of metastatic prostate adenocarcinoma in which a 68-year-old man presented with FHF. An abdominal CT scan revealed hepatomegaly without focal lesions, and Doppler ultrasound showed hepatomegaly and hepatic steatosis.…”

Section: Discussionmentioning

confidence: 99%

Rapid liver enlargement and hepatic failure secondary to radiographic occult tumor invasion: two case reports and review of the literature

et al. 2012

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IntroductionUnfamiliarity with certain clinical presentations, as illustrated in these cases, can lead to delayed diagnoses that in turn cause increased morbidity, prolonged hospitalization, and the need for autopsy.Case presentationIn Case 1, a 63-year-old Caucasian woman presented with hepatic enlargement and insufficiency which progressed and resulted in her death over a period of less than 2 weeks. The patient underwent a detailed workup included magnetic resonance imaging and computed tomography scan of her liver, which did not reveal the source of her liver enlargement. Due to her progressive liver enlargement and insufficiency, she developed a life-threatening esophageal variceal bleeding during her hospital stay which further delayed the attainment of her diagnosis. She finally underwent a videoscopic laparotomy and liver biopsy which revealed complete replacement and filling in of the liver sinuous with Indian filing lobular breast cancer. The patient died shortly after her diagnosis and before she could be discharged.In Case 2, a 68-year-old Caucasian woman with non-small-cell lung cancer was admitted to our Oncology in-patient service with a presentation of rapid hepatic insufficiency and severe liver enlargement. Like the patient in Case 1, during her hospitalization, this patient underwent a thorough radiographic evaluation, including computed tomography and magnetic resonance imaging, to identify the source of her symptoms. Radiographic imaging showed only hepatomegaly and no discrete focal lesions. As the multiple imaging studies over a period of a week did not reveal a clear cause for her symptoms, she finally underwent an interventional radiology core biopsy which showed complete replacement of her liver with non-small-cell lung cancer. Her condition rapidly progressed due to continued liver enlargement and she died due to frank liver failure before her diagnosis was affirmed and she could be discharged.ConclusionBoth of these cases illustrate the potential difficulties in diagnosing liver-infiltrative malignancy and the need for a high index of clinical suspicion for occult infiltrative malignancy in the liver to determine the appropriate therapeutic intervention, including further treatment of malignancy, palliative care, or determination of candidacy for liver transplantation. Because the diagnosis for the cause of symptoms and hepatomegaly was elucidated only by liver biopsy which occurred much later in their hospital course, both patients died while in the hospital instead of at home or in a hospice. Moreover, these delays in diagnosis and development of morbidities due to the progressing liver failure further prevent any possibility of early initiation of palliative treatment. Initial recognition of this type of presentation can lead to a prompt diagnostic biopsy and diagnosis. Giving the patient a correct diagnosis is one of the fundamental goals of oncology: a goal that, as illustrated in literature review, is not always achieved. Although treatment options in such cases often may be limi...

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“…In the case that they reported there was a good response to chemotherapy with improvement in the clinical status and liver function panel [4]. Shakir et al reported a case of fulminant hepatic failure in a patient with metastatic prostate cancer [5]. Depending on the severity of malignant infiltration obstructing the hepatic vasculature patient can present with features of hepatic ischemic injury, necrosis, and hepatic failure.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Mucinous Adenocarcinoma of the Cervix Presenting as Acute Hepatitis

Kundumadam

Laharwani

Azhikkalayil

et al. 2020

Cureus

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Cervical cancer is well known to cause metastasis in liver. Not usually they present in a pattern of acute hepatitis with the liver enzymes trending above the range of thousands. Here we present an interesting case of a patient who presented as acute hepatitis in the setting of metastatic cervical cancer to the liver. She presented with elevated liver enzymes above thousands. Her imaging studies revealed new metastatic lesions in the liver. She was subsequently started on chemotherapy but unfortunately, two months later developed septic shock and expired. To our knowledge this is the only case describing a malignancy with metastasis to the liver presenting as an acute hepatitis picture. All the other cases that have been described in the literature presented with acute liver failure.

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Metastatic Prostatic Carcinoma Presenting as Fulminant Hepatic Failure

Cited by 6 publications

References 9 publications

Asymptomatic persistent non-virus non-alcohol related elevation of aminotransferase levels: a rare case and review of the literature

Asymptomatic persistent non-virus non-alcohol related elevation of aminotransferase levels: a rare case and review of the literature

Rapid liver enlargement and hepatic failure secondary to radiographic occult tumor invasion: two case reports and review of the literature

Metastatic Mucinous Adenocarcinoma of the Cervix Presenting as Acute Hepatitis

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