Small-Cell Carcinoma of the Lung Manifesting as Acute Hepatic Failure

Abstract

In this report, we describe four cases of small-cell carcinoma of the lung manifesting as acute hepatic failure. These cases were noteworthy for the presence of hepatomegaly and substantially increased serum lactate dehydrogenase and uric acid levels. The ratio of normalized serum lactate dehydrogenase to normalized serum alanine aminotransferase from the 4 cases reported herein (mean +/- SE, 3.63 +/- 1.10) was significantly greater than the ratio obtained from the 12 cases of nonmalignant fulminant hepatic failure (mean +/- SE, 0.46 +/- 0.18; P < 0.001). Chest radiographs and abdominal imaging studies showed no neoplastic process in three of the four cases. Postmortem examinations disclosed extensive infiltration of the liver by metastatic small-cell carcinoma of the lung. A review of the literature revealed 13 additional similar cases. We conclude that metastatic small-cell carcinoma of the lung should be considered in cases of acute hepatic failure associated with hepatomegaly, substantially increased lactate dehydrogenase levels in comparison with alanine aminotransferase values, and increased uric acid levels even if imaging studies show no lesion. A liver biopsy done early during the hospital course is appropriate for diagnosis and for prevention of inappropriate transfer of the patient to a liver transplant center.

Fulminant Hepatic Failure as the Initial Manifestation of Small-Cell Lung Cancer: Report of 2 Cases

“…In addition, both patients died after a rapidly deteriorating course complicated by multiple organ failure. Previous case reports also show several similarities to the two cases reported herein, including the presence of massive hepatomegaly and an increase in the serum LDH [7][8][9][10][11][12][13] . The diagnosis could only be confirmed at postmortem examination in most of the reported cases also.…”

“…In the two cases reported herein and also the previously reported patients, there was an at least fivefold increase above the normal 7) . It has been suggested that an elevation of the serum LDH can be used as a prognostic indicator in SCLC patients with disturbed liver chemistry with hepatic failure and impending FHF 7) .…”

“…Among the laboratory findings, the serum LDH may be the most useful indicator of an underlying neoplastic diseases 7,8) . In the two cases reported herein and also the previously reported patients, there was an at least fivefold increase above the normal 7) .…”

“…SCLC manifesting as acute hepatic failure is extremely rare. The clinical course is usually very short after the development of hepatic failure, with rapid deterioration of the liver function and the development of multiorgan failure [7][8][9] . Making a diagnosis of hepatic infiltration in patients presenting with FHF in such cases is difficult and requires a high degree of suspicion if no evidence of the underlying primary disease is present, as usually is the case.…”

Prospective study of intratumoral microvessel density, p53 expression and survival in colorectal cancer

“…The incidence of lymph node metastasis (s s) does not change (P > 0.1), whereas the prevalence of haematogenous metastasis ( ) increased as IMD increased (P = 0.011) need to elicit microvessel development. Such an angiogenesisindependent growth pattern has been observed in tumours in the lungs and in the liver (McGuire et al, 1997;Pezzella et al, 1997). In this way, the angiogenic properties of the primary tumour, reflected in the IMD value, would not necessarily be related to the potential of metastases to expand.…”