Diffuse Liver Metastasis 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

Mishima, Saori; Nozaki, Yuichi; Mikami, Shintaro; Kihira, E.; Iikura, Motoyasu; Koketsu, Rikiya; Sugiyama, Haruhito; Masuda, Tomoshige; Kaname, Hikaru; Egami, Yuriko; Nakayama, Tomohiro; Kanehiro, Hiromichi; Nakamura, Hiroki; Igari, Toru; Watanabe, Kazuhiro; Nagata, Naoyoshi; Sakurai, Toshiyuki; Yokoi, Chizu; Kobayakawa, Masao; Kojima, Yasushi; Akiyama, Junichi; Imamura, Masatoshi; Masaki, Naohiko; Yanase, Mikio

doi:10.1159/000381140

Cited by 477 publications

(17 citation statements)

References 15 publications

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“…The potential short life span of patients with fulminant liver failure means prompt assessment is essential, however the cause can often remain undiagnosed in some patients. There are reports of fulminant liver failure in patients with breast1 and lung cancer,2 and liver metastases in any cancers can cause deranged liver function tests, but this case highlights a clinical liver failure presentation in oesophageal adenocarcinoma.…”

Section: Descriptionmentioning

confidence: 72%

Dysphagia to liver failure

et al. 2015

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DESCRIPTIONA 54-year-old man presenting with dysphagia, weight loss, epigastric pain and cervical lymphadenopathy was referred directly to endoscopy. The medical history included hypertension and hypercholesterolaemia. Blood tests showed normal bilirubin, aspartate transaminase (AST) 490 iu/L, γ-glutamyl transferase (GGT) 535 iu/L, alkaline phosphatase (ALP) 829 iu/L and prothrombin time (PT) 13 s.Gastroscopy showed a lower oesophageal lesion (figure 1) with biopsies showing high-grade dysplasia. A CT scan showed lower oesophageal wall thickening and multiple lymphadenopathy in the chest/abdomen but no liver metastases (figure 2). The local multidisciplinary team meeting outcome was for repeat oesophageal biopsies and supraclavicular lymph node biopsy to exclude a lymphoma.The patient thereafter clinically deteriorated over a 4-week period, developing jaundice. On admission, he became overtly encephalopathic within 48 h, with a suggestion of acute liver failure. Bloods revealed: bilirubin 238 μmol/L, AST 1034 iu/L, GGT 569 iu/L, ALP 887 iu/L, albumin 20 g/L, PT 27.2 s and lactate 4.7 mmol/L. Repeat imaging showed no signs of liver metastasis and acute liver screen was negative. Repeat oesophageal biopsies showed poorly differentiated adenocarcinoma. The patient rapidly deteriorated and died before a planned liver biopsy could be performed.Post mortem revealed disseminated oesophageal adenocarcinoma, lymph node metastases, ascites and diffuse liver metastases replacing the majority of the liver parenchyma. The potential short life span of patients with fulminant liver failure means prompt assessment is essential, however the cause can often remain undiagnosed in some patients. There are reports of fulminant liver failure in patients with breast 1 and lung cancer, 2 and liver metastases in any cancers can cause deranged liver function tests, but this case highlights a clinical liver failure presentation in oesophageal adenocarcinoma. Learning points▸ Liver metastases may not be apparent on CT or MRI modalities. ▸ Diffuse liver metastases can cause liver failure in oesophageal adenocarcinoma and if there is clinical suspicion, a liver biopsy may be helpful. ▸ While discrete liver metastases are common in different malignancies, diffuse infiltration and parenchymal replacement are relatively uncommon.

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Section: Descriptionmentioning

confidence: 72%

Dysphagia to liver failure

et al. 2015

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“…[4,5] Unusual metastases have been reported in skin, kidney, and thyroid gland. [5] Although liver metastases from SCLCs are relatively frequent, diffuse metastatic hepatomegaly from a small tumor is rarely reported.…”

Section: Discussionmentioning

confidence: 99%

“…[5] Although liver metastases from SCLCs are relatively frequent, diffuse metastatic hepatomegaly from a small tumor is rarely reported. [4,6] The nodules can be identified during CT-scan, but in other cases, the diffuse aspect or presence of nodules below 2 cm in diameter can mimick a cirrhosis and the metastases are under-recognized until autopsy. [4,6] In our case, the liver weighted 6.5 kg.…”

Section: Discussionmentioning

confidence: 99%

“…[4,6] The nodules can be identified during CT-scan, but in other cases, the diffuse aspect or presence of nodules below 2 cm in diameter can mimick a cirrhosis and the metastases are under-recognized until autopsy. [4,6] In our case, the liver weighted 6.5 kg. In the other 18 reported cases, the weight ranged between 1 and 3.5 kg.…”

Section: Discussionmentioning

confidence: 99%

“…Only 18 cases of SCLCs with diffuse liver metastases and fulminant liver failure have been published between 1979 and 2015. [4] No one of these cases showed a “coin-like” aspect even a synchronous tumor.…”

Section: Introductionmentioning

confidence: 99%

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Giant hepatic metastasis in a patient with coin-like small cell lung carcinoma incidentally diagnosed at autopsy

Fodor¹,

Gurzu

Contac³

et al. 2017

Medicine

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Rationale:Encephalopathy is a rare complication of hepatic metastases. In this paper we present a case of a patient with lung cancer and metastatic-related giant hepatomegaly.Patient concerns:A 78-year-old previously healthy male was admitted in the Emergency room in hepatic coma.Diagnoses:The abdominal CT scan examination revealed a huge liver filled with solid nodules.Interventions:No interventions were performed.Outcomes:The patient died at few hours after hospitalization. The autopsy showed a 6.5 kilograms liver with several whitish metastatic nodules and an occult prostate adenocarcinoma. The hilum of both lungs was free of tumor and a 10 mm white nodule was identified surrounding a small bronchus. No peripheral nodules were macroscopically identified. Under microscope, cluster of small cells were observed encasing a small bronchus with multiple minute coin-shaped subpleural foci. A massive intrapulmonary angiolymphatic invasion and metastases from small cell carcinoma in liver, lymph nodes and iliac crest bone marrow were also diagnosed.Lessons:This case highlights the difficulty of diagnosis of aggressive lung carcinomas and the necessity of checking for metachronous tumors. The encephalopathy might be the result of metastatic damage of the liver parenchyma combined with the paraneoplastic effect of the tumor cells. Few than 25 cases of SCLCs with diffuse liver metastases and fulminant liver failure were reported to December 2016. This is the first reported case with a synchronous prostate cancer and a “coin-like” aspect of the SCLC.

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Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

et al. 2020

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IMPORTANCE Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is important to understand outcomes associated with Medicaid coverage among patients with SCLC. OBJECTIVE To determine the association of Medicaid coverage with survival compared with other insurance statuses. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients with limitedstage (LS) and extensive-stage (ES) SCLC in the US National Cancer Database from 2004 to 2013. Data were analyzed in January 2019. MAIN OUTCOMES AND MEASURES Patients were analyzed with respect to insurance status. Associations of insurance status with survival were interrogated with univariate analyses, multivariable analyses, and propensity score matching. RESULTS A total of 181 784 patients with SCLC (93 131 [51.2%] female; median [interquartile range] age; 67 [60-75] years for patients with LS-SCLC and 68 [60-75] years for patients with ES-SCLC) were identified, of whom 70 247 (38.6%) had LS-SCLC and 109 479 (60.2%) had ES-SCLC. On univariate analyses of patients with LS-SCLC, Medicaid coverage was not associated with a survival advantage compared with being uninsured (hazard ratio, 1.02; 95% CI, 0.96-1.08; P = .49). Likewise, on multivariable analyses of patients with ES-SCLC, compared with being uninsured, Medicaid coverage was not associated with a survival advantage (hazard ratio, 1.00; 95% CI, 0.96-1.03; P = .78). After propensity score matching, median survival was similar between the uninsured and Medicaid groups both among patients with LS-SCLC (14.4 vs 14.1 months; hazard ratio, 1.05; 95% CI, 0.98-1.12; P = .17) and those with ES-SCLC (6.3 vs 6.4 months; hazard ratio, 1.00; 95% CI, 0.96-1.04; P = .92). CONCLUSIONS AND RELEVANCE Despite of billions of dollars in annual federal and state spending, Medicaid was not associated with improved survival in patients with SCLC compared with being uninsured in the US National Cancer Database. These findings suggest that there are substantial outcome inequalities for SCLC relevant to the policy debate on the Medicaid expansion under the Affordable Care Act.

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Diffuse Liver Metastasis 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

Cited by 477 publications

References 15 publications

Dysphagia to liver failure

Dysphagia to liver failure

Giant hepatic metastasis in a patient with coin-like small cell lung carcinoma incidentally diagnosed at autopsy

Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

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