Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Apr;27(3):203-206.
doi: 10.1159/000503150. Epub 2019 Oct 9.

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma

Ana Luísa Santos  1   2   3 , Vítor Magno Pereira  4 , Rosa Coelho  1   2   3 , Rui Gaspar  1   2   3 , Hélder Cardoso  1   2   3 , Joanne Lopes  2   5 , Guilherme Macedo  1   2   3
Affiliations
Case Reports

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma

Ana Luísa Santos et al. GE Port J Gastroenterol. 2020 Apr.

Abstract
in English, Portuguese

The authors describe a case of a 76-year-old male with a medical history of Merkel cell carcinoma (MCC) of the right lower eyelid. He was admitted to the emergency department due to abdominal pain in the right hypochondrium, nauseas, asthenia, and choluria with 3 days of evolution. Biochemical liver workup revealed a cytocholestase pattern as well as a prolonged prothrombin time. After admission, the patient developed hepatic encephalopathy, and a clinical and analytical worsening was observed. Abdominal ultrasound showed a reduction in the caliber of the hepatic veins, in apparent relation to a parenchymal compression. Liver biopsy was performed and showed an extensive infiltration of the hepatic parenchyma by a solid neoplasm, which, upon immunohistochemical study, was compatible with a diffuse metastization of a MCC. We report this clinical case due to its rarity of presentation and to show the important role of liver biopsy in cases of acute hepatitis.

Os autores descrevem o caso de um homem de 76 anos, com carcinoma de células de Merkel (CCM) da pálpebra direita, admitido no Serviço de Urgência por dor abdominal no hipocôndrio direito, náuseas, astenia e colúria com 3 dias de evolução. Analiticamente, apresentava um padrão citocolestático e coagulopatia com prolongamento do tempo de protrombina. Durante o internamento, desenvolveu encefalopatia hepática, com agravamento clínico e analítico. Ecograficamente, verificou-se redução do calibre das veias heapticas, em aparente relação com compressão parenquimatosa. Foi realizada biópsia hepática que relevou infiltração extensa do parênquima hepático por uma neoplasia sólida compatível, imunohis-toquimicamente, com metastização pelo CCM. Os autores reportam este caso clínico devido à raridade da sua apresentado, bem como para salientar o papel da biópsia hepática na abordagem dos casos de hepatite aguda.

Keywords: Hepatic encephalopathy; Liver biopsy; Liver failure; Liver metastases; Neuroendocrine carcinoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Abdominal ultrasound showing a reduction in the caliber of the hepatic veins, in apparent relation to a parenchymal compression.
Fig. 2
Fig. 2
Hematoxylin-eosin stain (×100) showing infiltration of the hepatic parenchyma by a solid neoplasm (hyperchromatic nuclei with scarce cytoplasm and with frequent apoptosis and mitosis figures).
Fig. 3
Fig. 3
Immunohistochemical analysis with synaptophysin.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lebbe C, Becker JC, Grob JJ, Malvehy J, Del Marmol V, Pehamberger H, et al. European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) Diagnosis and treatment of Merkel Cell Carcinoma. European consensus-based interdisciplinary guideline. Eur J Cancer. 2015 Nov;51((16)):2396–403. - PubMed
    1. Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features [Internet] J Am Acad Dermatol. 2008 Mar;58((3)):375–81. - PMC - PubMed
    1. Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study [Internet] J Cutan Pathol. 2010 Jan;37((1)):20–7. - PubMed
    1. Hayashi PH. Overview of causality assessment in drug-induced liver injury [Internet] Clin Liver Dis (Hoboken) 2017 Mar;9((2)):29–33. - PMC - PubMed
    1. EASL EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017 May;66((5)):1047–81. - PubMed

Publication types