Serra Francesco, Guidetti Cristiano, Spatafora Francesco, Cabry Francesca, Farinetti Alberto, Mattioli Anna Vittoria, Gelmini Roberta
Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena Italy Via del Pozzo, 71 41100, Modena, Italy.
Ann Med Surg (Lond). 2019 Jul 11;45:66-69. doi: 10.1016/j.amsu.2019.07.019. eCollection 2019 Sep.
Acute liver failure (ALF) secondary to malignant infiltration of the liver from urothelial carcinoma is a very rare clinical condition and is often diagnosed only after death. Upper tract urothelial carcinoma (UTUC) is a rare, from 5% to 10% of all urothelial tumours, but possible cause of ALF when there is extensive liver metastatic involvement. We report the case of a patient who died in the intensive care unit (ICU) of our hospital from multiple organ failure (MOF) secondary to ALF, as a result of infiltration of the liver from UTUC diagnosed after surgery.PRESENTATION OF THE CASE: A 69-year-old Caucasian man was referred to our hospital for hematuria, melena, right upper quadrant (RUQ) pain and jaundice developed over the previous two weeks. After multidisciplinary discussion, he underwent emergency exploratory laparotomy to perform cholecystectomy because of suspected acute cholecystitis considered as a septic focus within the left kidney. He developed MOF and died on the 6th postoperative day.
From the diagnosis of the renal mass and the death of the patient, a few days have passed, and the diagnosis of UTUC has been put only at histological examination.The most common sites of metastases from UTUC are lymph nodes, lungs, liver, bones and peritoneum. Moreover, liver metastases have been identified to have an independent negative impact on overall survival in a patient affected by UTUC.
The authors suggest that this condition should be taken into account when dealing with patients with evidence of a renal mass and simultaneous ALF.
尿路上皮癌肝脏恶性浸润继发的急性肝衰竭（ALF）是一种非常罕见的临床病症，通常仅在死后才能确诊。上尿路尿路上皮癌（UTUC）较为罕见，占所有尿路上皮肿瘤的5%至10%，但当出现广泛的肝脏转移受累时，可能是ALF的病因。我们报告一例患者，该患者在我院重症监护病房（ICU）因UTUC肝脏浸润继发多器官功能衰竭（MOF）导致ALF而死亡，UTUC在手术后确诊。
一名69岁的白种男性因血尿、黑便、右上腹（RUQ）疼痛和黄疸在过去两周内出现而被转诊至我院。经过多学科讨论，由于怀疑急性胆囊炎是左肾内的感染灶，他接受了急诊剖腹探查术以进行胆囊切除术。他出现了MOF并在术后第6天死亡。
从诊断出肾脏肿块到患者死亡，过去了几天时间，UTUC的诊断仅在组织学检查时才得以明确。UTUC最常见的转移部位是淋巴结、肺、肝脏、骨骼和腹膜。此外，已确定肝脏转移对UTUC患者的总生存期有独立的负面影响。
作者建议，在处理有肾脏肿块证据且同时伴有ALF的患者时，应考虑到这种情况。
