Fodor Decebal, Gurzu Simona, Contac Anca Otilia, Jung Ioan
Department of Pathology Research Center of University of Medicine and Pharmacy Department of Pathology, Clinical County Emergency Hospital, Tirgu-Mures, Romania.
Medicine (Baltimore). 2017 Mar;96(11):e6366. doi: 10.1097/MD.0000000000006366.
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.
A 78-year-old previously healthy male was admitted in the Emergency room in hepatic coma.
The abdominal CT scan examination revealed a huge liver filled with solid nodules.
No interventions were performed.
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.
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.
肝转移瘤的罕见并发症是肝性脑病。本文报告一例肺癌伴转移相关巨肝症患者。
一名78岁既往健康男性因肝昏迷入住急诊室。
腹部CT扫描检查显示肝脏巨大，布满实性结节。
未采取任何干预措施。
患者住院数小时后死亡。尸检显示肝脏重达6.5千克，有多个白色转移结节，同时发现隐匿性前列腺腺癌。双肺肺门无肿瘤，在一小支气管周围发现一个10毫米白色结节。肉眼未发现外周结节。显微镜下观察到小细胞簇包绕一小支气管，并有多个微小硬币状胸膜下病灶。还诊断出存在大量肺内血管淋巴管浸润以及小细胞癌转移至肝脏、淋巴结和髂嵴骨髓。
该病例凸显了侵袭性肺癌诊断的困难以及检查异时性肿瘤的必要性。肝性脑病可能是肝实质转移损伤与肿瘤细胞副肿瘤效应共同作用的结果。截至2016年12月，报道的小细胞肺癌伴弥漫性肝转移和暴发性肝衰竭病例少于25例。这是首例报道的同时合并前列腺癌且小细胞肺癌呈“硬币样”表现的病例。
