Metastatic Small Cell Lung Cancer Spread to Liver Oncologist Reviews

Pocket-size-cell lung cancer (SCLC) is a subgroup of lung cancer with a high frequency of liver metastasis, which is a predictor of poor prognosis. Lengthened liver metastases of SCLC with no visible nodular lesions in the liver when examined using computed tomography (CT) are relatively rare; withal, a few cases with rapid progression to acute liver failure that were diagnosed after death have been reported. In this paper, we report a 63-year-sometime man with diffuse liver metastases of SCLC that were histologically diagnosed using a transjugular liver biopsy while the patient was live, fifty-fifty though no lesions were visible during a dissimilarity-enhanced CT examination.

© 2015 South. Karger AG, Basel

Introduction

The liver is one of the almost frequent targets of metastasis from primary cancerous tumors. Almost metastatic liver tumors are diagnosed using imaging techniques such as contrast-enhanced computed tomography (CT); these imaging techniques are oftentimes performed to evaluate the stage of malignancy. Nevertheless, diffuse-type liver metastasis tumors without nodular lesions are considerably rare, even when dissimilarity-enhanced CT examinations are performed; thus, an accurate diagnosis is difficult to obtain prior to death, and some cases may develop acute liver failure or, occasionally, disseminated intravascular coagulation, making a percutaneous liver biopsy difficult to perform. Therefore, virtually cases are diagnosed histologically every bit diffuse liver metastasis on a mail-mortem basis. Modest-cell lung cancer (SCLC) comprises approximately 15% of all lung cancers [ane] and is a subgroup of chief lung cancer that is known for its ambitious and rapid growth and early on metastasis. SCLC is associated with a poor prognosis and limited treatment options, particularly in cases with liver metastasis [2]. Nosotros present the first report of a rare case in whom diffuse liver metastasis of SCLC was diagnosed histologically using a transjugular liver biopsy while the patient was live, despite the absence of whatsoever visible lesions when examined using dissimilarity-enhanced CT. Unfortunately the condition of this patient rapidly progressed to acute liver failure before the indications for chemotherapy could be met.

Example Report

A 63-twelvemonth-old male was referred to our infirmary for further care because of a considerable torso weight loss (10 kg over a one-year period), bloody phlegm for a few months and jaundice for a few days. He had visited some other infirmary because of hypertension and had never exhibited liver dysfunction during a routine health check-upwardly. He had a past medical history of diabetes mellitus and tonsillitis. He also had a history of heavy smoking and booze consumption. While his vital signs upon examination were inside the normal range (blood pressure level 131/lxx mm Hg, pulse rate 86/bpm, torso temperature 36.iii°C), his physical examination showed significant jaundice and hepatomegaly. His laboratory data revealed height of serum liver enzyme levels (aspartate aminotransferase 102 IU/l, alanine aminotransferase 88 IU/l, lactate dehydrogenase 650 IU/l, alkaline phosphatase 723 IU/l, γ-glutamyltransferase 835 IU/50) and jaundice (full bilirubin 9.8 mg/dl, directly bilirubin vii.9 mg/dl). His serum albumin level and platelet counts were decreased (albumin 2.5 g/dl, platelets 4.2 × 10^four/μl). The prothrombin time was slightly prolonged (74.7%). Equally for tumor markers, the ProGRP level was prominently increased to 24,000 pg/ml. Contrast-enhanced CT scans revealed a right lung tumor with a size of 15 mm and multiple lymph node metastases, pleural dissemination and a suspected left adrenal metastasis (fig. ane). The liver findings only showed hepatomegaly without any intrahepatic nodular lesions when using contrast-enhanced CT (fig. 2a); diffuse minimal loftier-echoic nodular shadows were visible during ultrasound examination (fig. 2b). Based on a transbronchial needle aspiration of a mediastinal lymph node, he was diagnosed as having phase Iv SCLC (fig. 3a). Further examination to evaluate the cause of the liver dysfunction was needed earlier determining the chemotherapy options, and a transjugular liver biopsy was performed. A percutaneous transhepatic arroyo was not feasible because of a bleeding tendency. Histologically, the patient was diagnosed as having diffuse metastatic SCLC in the liver, with positive immunohistological findings for chromogranin A, synaptophysin, CD56, TTF-one and AE1/AE3 and with a Ki-67 index of 80% (fig. 3b). Thereafter, the patient's general condition and liver failure worsened quite rapidly, and all-time supportive care was selected. He died 13 days after hospital admission.

Fig. 1

Contrast-enhanced CT scans revealed a correct lung tumor with a size of 15 mm and multiple lymph node metastases (arrows).

Fig. 2

a Contrast-enhanced CT scans showed only hepatomegaly without any intrahepatic nodular lesions. b An ultrasound sonography exam revealed merely lengthened minimal loftier-echoic nodular shadows.

Fig. iii

a Cytology from a mediastinal lymph node by transbronchial needle aspiration revealed SCLC (×400). b Histological test of the liver revealed diffuse liver metastases of SCLC, all of which were positive for chromogranin A, synaptophysin, CD56, TTF-i and AE1/AE3 and with a Ki-67 index of fourscore% (hematoxylin and eosin: ×twoscore, ×400; chromogranin A, CD56, TTF-i, AE1/AE3, Ki-67: ×400).

Discussion

SCLC accounts for approximately 15-18% of all lung cancers; it is the leading cause of cancer death in men worldwide and is strongly associated with smoking. The poor survival charge per unit of SCLC is related to its invasive tendency and its high charge per unit of metastasis, and the identification of liver metastasis has been shown to exist a significant indicator of a poor prognosis [2]. Liver metastasis is diagnosed in almost 50% of patients with all-encompassing-stage SCLC [3]; however, lengthened parenchymal metastasis correlated with liver failure is an unusual and extremely rare pattern of liver metastasis. CT examinations are generally preferred for the staging of malignancy. Nonetheless, in cases with diffuse malignant infiltration of the hepatic sinusoids, patently CT imaging can fail to detect gross hepatic nodules [4], while contrast-enhanced CT can reveal diffuse multiple low-density, hypovascular areas in the liver [5]; in these cases, magnetic resonance imaging or FDG-PET may be useful for staging purposes [6]. Furthermore, about all cases reported as having lengthened liver metastasis of SCLC exhibit rapid progression to acute liver failure and death. Therefore, diffuse liver metastasis is mostly diagnosed afterward death. As for the underlying mechanism of the progression of hepatic metastasis of SCLC to acute liver failure, massive diffuse sinusoidal infiltration and obstructive invasion of the hepatic vessels past tumor cells as well as replacement of normal liver parenchyma with malignant cells accept been reported to outcome in hepatocyte ischemia and necrosis [5].

Seventeen well-described cases of diffuse liver metastases of SCLC causing acute liver failure have been previously reported [4,5,six,7,viii,9,10,11,12,13,14], and these cases differ from cases of liver predominant/primary small-cell carcinoma [fifteen]. None of these 17 cases had been histologically diagnosed prior to death, despite the absenteeism of whatsoever visible nodular lesions in the liver observed using dissimilarity-enhanced CT. Since coagulation abnormalities usually prohibit liver biopsy, in example of a high take chances of bleeding, alternative biopsy techniques such as transjugular liver biopsy should be favored [eleven]. Thus, every bit far every bit we know, the case reported here is the get-go instance of diffuse liver metastasis of SCLC diagnosed histologically based on a transjugular liver biopsy while the patient was live, with no nodular lesions visible in the liver fifty-fifty using a dissimilarity-enhanced CT browse of the abdomen. However, in our case, appropriate chemotherapy could not be performed because of the severe liver dysfunction at the time of diagnosis.

In decision, nosotros report a case of diffuse liver metastasis of SCLC diagnosed histologically based on a transjugular liver biopsy that progressed rapidly to acute liver failure. A liver biopsy may be indicated early during the clinical course of SCLC patients with liver dysfunction and hepatomegaly.

Acknowledgments

The skillful technical assistance of Nami Michiaki is gratefully best-selling. This study was supported in part by a grant for National Center for Global Wellness and Medicine (26A-107) to Y. Nozaki.

Disclosure Statement

None of the authors has any conflict of interest to declare concerning the material presented in this paper.

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