Chandradevan Raguraj, Takeda Hironobu, Hayes Benjamin, Faulkner Kalli, Darrow Matthew
Graduate Medical Education-Internal Medicine, Northside Hospital Gwinnett, Lawrenceville, GA, USA.
Department of Pathology, Northside Hospital Gwinnett, Lawrenceville, GA, USA.
Oxf Med Case Reports. 2020 May 6;2020(3):omaa019. doi: 10.1093/omcr/omaa019. eCollection 2020 Mar.
A 70-year-old female with a history of lobular carcinoma of the breast, status post-mastectomy followed by adjuvant radio-chemotherapy in remission for 4 years was admitted with the features of acute liver failure (ALF). Iron studies revealed a hemochromatosis picture and the CT and MRI scans of the abdomen suggested cirrhosis. An extensive workup failed to identify an etiology. A trans-jugular liver biopsy was obtained and revealed poorly differentiated carcinoma consistent with the metastasis of breast primary. The patient's condition deteriorated and died within a week following the onset of acute hepatic failure. DNA testing revealed that the patient was heterozygous for H63D mutation. In cases of ALF with the suspicion of malignancy, liver biopsy should be obtained to evaluate an infiltrative hepatic disease.
一名70岁女性，有乳腺小叶癌病史，乳房切除术后接受辅助放化疗，病情缓解4年，因急性肝衰竭（ALF）症状入院。铁代谢检查显示为血色素沉着症表现，腹部CT和MRI扫描提示肝硬化。全面检查未能明确病因。进行了经颈静脉肝活检，结果显示为低分化癌，符合乳腺原发癌转移。患者病情恶化，在急性肝衰竭发作后一周内死亡。DNA检测显示患者H63D突变呈杂合状态。对于怀疑有恶性肿瘤的急性肝衰竭病例，应进行肝活检以评估浸润性肝病。
