Fulminant Hepatic Failure as the Initial Manifestation of Small-Cell Lung Cancer: Report of 2 Cases

DOI Web Site 参考文献8件
  • Terashima Takeshi
    Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital
  • Matsuzaki Tatsu
    Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital
  • Ogawa Rika
    Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital
  • Naitou Asuka
    Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital
  • Inokuchi Sayaka
    Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital
  • Kaida Shogo
    Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital
  • Kishikawa Hiroshi
    Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital
  • Nishida Jiro
    Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital
  • Tanaka Yoichi
    Department of Clinical Pathology, Tokyo Dental College Ichikawa General Hospital
  • Miyauchi Jun
    Department of Clinical Pathology, Tokyo Dental College Ichikawa General Hospital
  • Morishita Tetsuo
    Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital
  • Ishizaka Akitoshi
    Department of Internal Medicine, Keio University, School of Medicine

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In this report, we describe two cases of small-cell lung cancer (SCLC) presenting with fulminant hepatic failure as the initial manifestation. Neither of the patients had a previous history of liver disease, evidence of viral infection, or exposure to hepatotoxins. Both presented with hepatomegaly and an increase in the serum LDH level. Although they had a history of smoking and respiratory symptoms such as dyspnea on exertion, their most striking initial symptoms were those of hepatic failure, which made it difficult to suspect the underlying primary lung cancer. In one case, contrast-enhanced CT of the abdomen revealed hypovascular nodules that were not visible on plain CT. After a rapidly deteriorating course, both patients died, 8 and 13 days after admission, respectively. Autopsy revealed diffuse infiltration of the hepatic sinusoids and extensive replacement of the liver parenchyma by metastatic small-cell carcinoma. We conclude that metastatic SCLC should be considered in the differential diagnosis in patients of advanced age with a smoking history presenting with rapidly progressive liver failure associated with hepatomegaly and elevation of the serum LDH.

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