Acute liver failure due to radiographically occult infiltration of urothelial cancer

Authors

  • Valentina Tosatto Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Department of Internal Medicine 4, Lisboa, Portugal / Universidade Nova de Lisboa, NOVA Medical School, Lisboa, Portugal https://orcid.org/0000-0002-6456-3764
  • João Cabral Pimentel Centro Hospitalar Universitário de Lisboa Central, Hospital de São José, Department of Anatomical Pathology, Lisboa, Portugal https://orcid.org/0000-0003-1908-8607
  • Cristiano Cruz Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Department of Internal Medicine 4, Lisboa, Portugal https://orcid.org/0000-0001-9681-5922
  • André Almeida Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Department of Internal Medicine 4, Lisboa, Portugal / Universidade Nova de Lisboa, NOVA Medical School, Lisboa, Portugal https://orcid.org/0000-0003-0360-7011
  • Matteo Boattini University Hospital Città della Salute e della Scienza di Torino, Microbiology and Virology Unit, Turin, Italy https://orcid.org/0000-0001-6726-2716

Keywords:

Neoplasms, Biopsy, Palliative Care

Abstract

Introduction: Acute liver failure (ALF) due to diffuse infiltrating solid malignancy without any focal lesions on radiographic imaging is rare. Case report: A 70-year-old man was admitted due to mental confusion, abdominal pain, and ALF. Three years before, he had undergone a left nephrectomy for urothelial carcinoma followed by adjuvant chemotherapy. The abdominal computed tomography (CT) showed hepatomegaly and ascites. Ascitic fluid had transudate characteristics, with no malignant cells. Percutaneous liver biopsy (LB) showed diffuse liver infiltration of metastatic urothelial carcinoma. The patient rapidly deteriorated and died in a week due to ALF. Discussion: History of solid cancer and hepatomegaly and/or liver failure without other obvious explanation should encourage to perform LB. Conclusion: LB is warranted to avoid misdiagnosis, prolonged hospital stays, and delay in palliative care.

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Published

2021-03-12

How to Cite

Tosatto, V., Cabral Pimentel, J., Cruz, C., Almeida, A., & Boattini, M. (2021). Acute liver failure due to radiographically occult infiltration of urothelial cancer. Autopsy and Case Reports, 11, e2021256. Retrieved from https://www.revistas.usp.br/autopsy/article/view/183644

Issue

Section

Article / Clinical Case Report