RAPID HEPATIC-FAILURE ASSOCIATED WITH A CONTRACTED LIVER MIMICKING CIRRHOSIS IN A CASE OF NASOPHARYNGEAL CARCINOMA WITH LIVER METASTASIS

A 46-year-old women had an undifferentiated nonkeratinizing nasopharyn geal carcinoma, locally controlled by radiotherapy. Initially, she had normal liver function tests and normal hepatic ultrasonography. Seven months later, she experienced a rapidly progressive hepatic failure m anifested by the development of ascites, elevation of serum bilirubin level, and prolongation of prothrombin time. Imaging studies showed a contracted liver and serum biochemical tests were compatible with chro nic liver disease, except for an increase of alkaline phosphatase and gamma-glutamyl transpeptidase levels. An endoscopic retrograde cholang iogram was compatible with changes of sclerosing cholangitis. The pati ent died of hepatic decompensation within two months. A liver necropsy disclosed diffuse infiltration of carcinoma cells into the hepatic si nusoids and obliterative angio-invasion of the tumor cells with massiv e fibrotic stroma replacing almost all hepatocytes. In situ hybridizat ion demonstrated expression of Epstein-Barr virus transcripts EBER1 in the tumor cells and proved a metastatic nasopharyngeal carcinoma. The contracted liver is likely to be explained by the tumor-associated de smoplastic change and the obliterative angio-invasion of the tumor. It is important to be aware that, although rare, such an unusual pattern of liver metastasis may mimick cirrhosis clinically and cause rapid h epatic failure in patients with nasopharyngeal carcinoma. (C) Munksgaa rd, 1996.