title: [Fulminant hepatic insufficiency caused by diffuse intrasinusoidal liver metastases in a patient with transitional-cell carcinoma of the bladder].
abstract: OBJECTIVE
  To present a case of transitional cell carcinoma of the bladder with diffuse intrasinusoidal metastases to the liver that presented as fulminant hepatic failure.
  
  
  RESULTS
  A 65-year-old patient who presented at the emergency department of this hospital with fever and pain in the right hypochondrium and flank is described. Three months previously the patient had undergone operation in our department for a recurrence of a tumor affecting the bladder and urethra (Tis of the bladder and T1 GII of the prostatic urethra). The blood tests on admission were practically normal but showed alterations from the twelfth day onwards, suggesting acute liver failure in the differential diagnosis; the patient died 21 days later. The ultrasound and CT scans showed hepatomegaly with multiple heterogeneous areas which were not visible three months earlier and with no space-occupying lesions. At autopsy, the liver was found to be enlarged, with no macroscopic metastatic nodules. Microscopic examination revealed massive tumoral infiltration of the hepatic sinusoids with diffuse replacement of the hepatocytes.
  
  
  CONCLUSIONS
  Secondary, metastatic liver cancer usually presents as multiple nodular lesions and only vary on very rare occasions as a diffuse infiltration leading to acute hepatic failure. This case provides the first description of the autopsy findings in a bladder transitional cell carcinoma with diffuse intrasinusoidal metastases to the liver.
authors.affiliation: Departamento de Urología, Hospital San Agustín, Avilés, Asturias, España. jmlanzas@terra.es
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Lanzas Prieto
authors.forename: José María
authors.initials: JM
authors.lastname: Alonso de la Campa
authors.forename: José Luis
authors.initials: JL
authors.lastname: Guate Ortiz
authors.forename: Juan
authors.initials: J
authors.lastname: González Tuero
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Pérez García
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gutiérrez García
authors.forename: Francisco
authors.initials: F
authors.lastname: González Naranjo
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000556:secondary*; D017809:Fatal Outcome; D006801:Humans; D017093:Liver Failure / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary*; D008297:Male; D012907:Smoking; D001749:Urinary Bladder Neoplasms / Q000473:pathology*