Severe Lactic Acidosis in a 14-Year-Old Female With Metastatic Undifferentiated Carcinoma of Unknown Primary

Abstract

A 14-year-old girl was found to have a large, non-tender breast mass with anemia and thrombocytopenia. The diagnosis of an undifferentiated carcinoma of unknown primary was made after open breast biopsy of the mass with negative immunohistochemical studies for breast malignancies. Further evaluation showed extensive metastatic disease affecting the bone marrow, ribs, liver, and brain with magnetic resonance imaging evidence of carcinomatous meningitis. Despite 2 months of chemotherapy and intensive supportive care, the patient died of severe lactic acidosis and disseminated intravascular coagulation after exaggerated menstrual bleeding. The association of severe lactic acidosis and undifferentiated carcinoma of unknown primary in an adolescent has not been previously described.

Massive Infiltration of Liver by Metastatic Adenocarcinoma: A Rare Cause of Acute Hepatic Failure

“…23,24 In our patient we found a disproportionate rise in serum lactate levels compared to prothrombin time prolongation. We believe this observation may serve as a clue to predict malignancyinduced FHF.…”

Serum lactate as a potential biomarker of non-glial brain tumors

“…Field et al first described Type B lactic acidosis in patients with acute leukemia [8,9]. Since then, lactic acidosis has been observed in patients with both hematological malignancies and some non-hematological tumors such as small cell carcinoma of the lung, breast cancer, cholangiocarcinoma, gynecological cancers and metastatic tumors of unknown primary carcinoma [10][11][12][13][14][15]. Of the 12 patients with brain metastases and elevated serum lactate, five had carcinoma of the lung, five had primary of the breast, one had malignant melanoma and one had hepatocellular carcinoma.…”

Ketones and lactate “fuel” tumor growth and metastasis

“…[23][24][25][26][27][28][29][30][31][32][33] In fact, lactic-acidosis (due to the over-production and/or accumulation of serum lactate) is often the cause of death in patients with metastatic breast cancer, or other types of metastatic cancer. [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] However, a causative role for L-lactate production in tumor metastatic progression has not yet been suggested or demonstrated.…”