Tosatto V, Pimentel JC, Cruz C, Almeida A, Boattini M. Acute liver failure due to radiographically occult infiltration of urothelial cancer.
AUTOPSY AND CASE REPORTS 2021;
11:e2021256. [PMID:
34307219 PMCID:
PMC8214878 DOI:
10.4322/acr.2021.256]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction
Acute liver failure (ALF) due to diffuse infiltrating solid malignancy without any focal lesions on radiographic imaging is rare.
Case report
A 70-year-old man was admitted due to mental confusion, abdominal pain, and ALF. Three years before, he had undergone a left nephrectomy for urothelial carcinoma followed by adjuvant chemotherapy. The abdominal computed tomography (CT) showed hepatomegaly and ascites. Ascitic fluid had transudate characteristics, with no malignant cells. Percutaneous liver biopsy (LB) showed diffuse liver infiltration of metastatic urothelial carcinoma. The patient rapidly deteriorated and died in a week due to ALF.
Discussion
History of solid cancer and hepatomegaly and/or liver failure without other obvious explanation should encourage to perform LB.
Conclusion
LB is warranted to avoid misdiagnosis, prolonged hospital stays, and delay in palliative care.
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