title: Malignant infiltration of the liver presenting as acute liver failure.
abstract: There have been few reports of acute liver failure (ALF), with encephalopathy and coagulopathy, caused by infiltration of the liver by malignant cells. We describe a case series of 27 patients with ALF caused by malignancy. We examined a large, multicenter ALF registry (1910 patients; mean age, 47.1 ± 13.9 y) and found only 27 cases (1.4%) of ALF attributed to malignancy. Twenty cases (74%) presented with abdominal pain and 11 presented with ascites. The most common malignancies included lymphoma or leukemia (33%), breast cancer, (30%), and colon cancer (7%); 90% of the patients with lymphoma or leukemia had no history of cancer, compared with 25% of patients with breast cancer. Overall, 44% of the patients had evidence of liver masses on imaging. Diagnosis was confirmed by biopsy in 15 cases (55%) and by autopsy for 6 cases. Twenty-four patients (89%) died within 3 weeks of ALF.
authors.affiliation: Division of Gastroenterology and Hepatology, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Rich
authors.affiliation: Division of Gastroenterology and Hepatology, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Corron
authors.initials: C
authors.lastname: Sanders
authors.affiliation: Division of Gastroenterology and Hepatology, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Hughes
authors.affiliation: Division of Gastroenterology, The University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Oren
authors.initials: O
authors.lastname: Fix
authors.affiliation: Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Han
authors.affiliation: Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Willscott E
authors.initials: WE
authors.lastname: Naugler
authors.affiliation: Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Atif
authors.initials: A
authors.lastname: Zaman
authors.affiliation: Division of Gastroenterology and Hepatology, The University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: William.lee@UTSouthwestern.edu.
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000328:Adult; D001706:Biopsy; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000473:pathology; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000473:pathology; D006651:Histocytochemistry; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D016019:Survival Analysis
keywords: Acute Liver Failure; Liver Transplantation; Malignancy