Giant metastatic liver in a patient with small-cell neuroendocrine carcinoma of the lung

Excerpt

Sir, The liver is a very common site for metastases, carcinomas of the gut, lung, and breast being among the most frequent primary tumours. We report the unique case of a small-cell neuroendocrine carcinoma of the lung producing multiple metastases in the liver, which led to a gigantic hepatomegaly with a weight of nearly 20 kg. To the best of the authors’ knowledge, such an extreme degree of hepatomegaly has never been reported before, neither in inflammatory nor in neoplastic disease. The patient, a 53-year-old male, presented with a 3-month history of abdominal pain, weight loss of about 10 kg and generalised jaundice. A computed tomography of the abdomen revealed multiple disseminated lesions in the liver, which were interpreted as metastatic disease. A biopsy specimen was obtained from the liver. Histology revealed diffuse infiltrates of small pleomorphic tumour cells coexpressing cytokeratin 7, synaptophysin, chromogranin alpha and TTF1 (Fig. 1). The diagnosis of a small-cell neuroendocrine carcinoma, probably of lung origin, was made. The patient, therefore, underwent only palliative treatment. He finally died, with signs of liver failure, due to progressive neoplastic disease. Autopsy revealed a greyish-white tumour measuring 2 cm in largest diameter within the upper lobe of the left lung. There was an unusually huge hepatomegaly with a liver size of 50×40×18 cm (compared with normal values of 25×18×10 cm). More than 90% of the hepatic tissue was replaced by disseminated, sometimes merging, tumour metastases, with a maximum diameter of about 10 cm (Fig. 2). The metastases were relatively sharply demarcated from the surrounding hepatic tissue and showed focal haemorrhage and necroses. Altogether, the total mass of the metastatic tumour within the liver was estimated to be around 17–18 kg, i.e. about 15% of the total body weight of 136 kg.

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