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

Abstract

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.

Sudden onset acute liver failure in a patient with clinically occult small cell lung carcinoma: autopsy report and review of the medical literature

“…In the other 35 reported cases, the liver weight ranged between 1.4 and 8.2 kg;21 , 27 in our case, the liver weighed 4.25 kg.…”

Transarterial Chemoembolization (TACE) with Lipiodol� in HCC PatientsTechnical, clinical and imagistic aspects

“…* new tumoral tissue in comparison to the previous examination before TACE ' viable tumoral tissue localized circumferential to the area of tumoral necrosis ,"tumoral halo" aspect † CT signs that suggest tumoral necrosis feasible initially due to tumor size) or liver resection in apparently inoperable cases [30][31][32][33]. Conclusions TACE is a feasible technique which assures downstaging of HCC, bridging to curative treatment and a notable way of increasing life quality for patients.…”