Rapid hepatic failure associated with a contracted liver mimicking cirrhosis in a case of nasopharyngeal carcinoma with liver metastasis
Journal
Liver
Journal Volume
16
Journal Issue
4
Pages
283-287
Date Issued
1996
Author(s)
Abstract
A 46-year-old women had an undifferentiated nonkeratinizing nasopharyngeal carcinoma, locally controlled by radiotherapy. Initially, she had normal liver function tests and normal hepatic ultrasonography. Seven months later, she experienced a rapidly progressive hepatic failure manifested by the development of ascites, elevation of serum bilirubin level, and prolongation of prothrombin time. Imaging studies showed a contracted liver and serum biochemical tests were compatible with chronic liver disease, except for an increase of alkaline phosphatase and γ-glutamyl transpeptidase levels. An endoscopic retrograde cholangiogram was compatible with changes of sclerosing cholangitis. The patient died of hepatic decompensation within two months. A liver necropsy disclosed diffuse infiltration of carcinoma cells into the hepatic sinusoids and obliterative angio-invasion of the tumor cells with massive fibrotic stroma replacing almost all hepatocytes. In situ hybridization demonstrated expression of Epstein-Barr virus transcripts EBER1 in the tumor cells and proved a metastatic nasopharyngeal carcinoma. The contracted liver is likely to be explained by the tumor-associated desmoplastic change and the obliterative angio-invasion of the tumor. It is important to be aware that, although rare, such an unusual pattern of liver metastasis may mimick cirrhosis clinically and cause rapid hepatic failure in patients with nasopharyngeal carcinoma.
SDGs
Other Subjects
alkaline phosphatase; bilirubin; gamma glutamyltransferase; adult; alkaline phosphatase blood level; article; ascites; autopsy; bilirubin blood level; case report; diagnostic imaging; differential diagnosis; echography; endoscopic retrograde cholangiopancreatography; Epstein Barr virus; female; gamma glutamyl transferase blood level; human; in situ hybridization; liver cirrhosis; liver failure; liver function test; liver metastasis; liver sinusoid; nasopharynx carcinoma; prothrombin time; sclerosing cholangitis
Publisher
Blackwell Publishing Ltd
Type
journal article