title: Fulminant hepatic failure caused by diffuse intrasinusoidal metastatic liver disease: a case report.
abstract: A 53-year-old woman experienced rapidly progressing liver failure four years after a quadrantectomy for a breast carcinoma. She had received adjuvant chemotherapy and radiotherapy, and second-line chemotherapy for bone metastasis one year earlier. The hepatic failure manifested with ascites, jaundice, elevation of serum bilirubin and hepatic enzyme levels and hypoalbuminemia. Imaging studies showed an enlarged liver without metastatic lesions. The patient died of hepatic decompensation within two weeks. Liver examination at autopsy revealed massive neoplastic infiltration consistent with a primary breast carcinoma. It is important to realize that this unusual pattern of liver metastasis cannot be demonstrated even with the most advanced techniques of instrumental diagnosis (CT scan, ultrasonography and magnetic resonance imaging), and should be taken into account in the differential diagnosis of rapidly progressing liver failure.
authors.affiliation: Divisione Oncologia, Azienda Complesso Ospedaliero S. Filippo Neri, Rome, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Martelli
authors.forename: L
authors.initials: L
authors.lastname: Coppola
authors.forename: A L
authors.initials: AL
authors.lastname: De Quarto
authors.forename: M
authors.initials: M
authors.lastname: Palma
authors.forename: R
authors.initials: R
authors.lastname: Sarmiento
authors.forename: C M
authors.initials: CM
authors.lastname: Foggi
mesh_terms: D001344:Autopsy; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000378:metabolism / Q000556:secondary*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000556:secondary*; D008875:Middle Aged; D017211:Treatment Failure