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首页> 外文期刊>Tumori. >Acute liver failure as the initial manifestation of hepatic infiltration by a solid tumor: report of 5 cases and review of the literature.
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Acute liver failure as the initial manifestation of hepatic infiltration by a solid tumor: report of 5 cases and review of the literature.

机译：急性肝功能衰竭为实体瘤肝浸润的最初表现：5例报告并文献复习。

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BACKGROUND: Acute liver failure is a rare complication of metastatic liver disease with a high mortality. Recognition of malignant infiltration of the liver as the cause of acute liver failure could be a diagnostic challenge. PATIENTS: The medical files of 5 patients with acute liver failure due to metastatic liver disease collected over a 4-year period (1997-2000) in our department were reviewed. RESULTS: No patient had a past history of cancer. The interval from jaundice to encephalopathy ranged from 7 to 12 days (median, 10). Physical examination revealed hepatomegaly and deep jaundice in all patients. AST elevation ranged from 147 to 1870 IU/L (median, 716 IU/L) and ALT elevation from 74 to 556 IU/L (median, 138 IU/L). All patients died within 4-14 days (median, 7) of admission. None had papillary edema or decerebrate posture before death. Four patients had concurrent renal impairment. Liver imaging studies in 2 of the 5 patients were nondiagnostic and the malignant liver infiltration was confirmedpostmortem. Liver histology in all cases showed massive tumoral infiltration of the hepatic sinusoids with diffuse replacement of hepatocytes. The primary tumors were colon, gastric, small cell lung, pancreas and cancer of unknown origin. CONCLUSIONS: Malignant infiltration of the liver should be taken into account in the differential diagnosis of rapidly progressive liver failure. Although effective chemotherapy has improved the survival of patients with metastatic liver disease, there has been no change in the course and outcome of acute liver failure due to malignant infiltration of the liver over the last 2 decades. A proper diagnosis by liver biopsy is mandatory to prevent such patients from being considered for liver transplant.
机译：背景：急性肝衰竭是转移性肝病的罕见并发症，死亡率高。认识到恶性肝浸润是急性肝衰竭的原因可能是诊断上的挑战。患者：回顾了我科在4年间（1997-2000年）收集的5例因转移性肝病引起的急性肝衰竭的病历。结果：没有患者有过癌症史。黄疸到脑病的间隔时间为7到12天（中位数为10）。体格检查发现所有患者均出现肝肿大和黄疸。 AST升高范围为147至1870 IU / L（中位数为716 IU / L），ALT升高范围为74至556 IU / L（中位数为138 IU / L）。所有患者均在入院后4-14天内死亡（中位数为7）。死亡前均无乳头水肿或无脑姿势。四名患者并发肾功能不全。 5例患者中有2例的肝影像学检查未确诊，死后证实为恶性肝浸润。在所有情况下，肝组织学检查均显示肝窦有大量肿瘤浸润，并伴有肝细胞的弥漫性置换。原发性肿瘤为结肠癌，胃癌，小细胞肺癌，胰腺癌和未知来源的癌症。结论：在快速进行性肝衰竭的鉴别诊断中应考虑到肝的恶性浸润。尽管有效的化学疗法改善了转移性肝病患者的生存率，但在过去的20年中，由于肝脏恶性浸润而导致的急性肝衰竭的过程和结果没有改变。必须通过肝活检进行适当的诊断，以防止考虑将此类患者进行肝移植。

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