ACUTE LIVER-FAILURE DUE TO DIFFUSE INTRASINUSOIDAL METASTASES OF UROTHELIAL CARCINOMA

We report one case of urothelial carcinoma with diffuse intrasinusoida l metastasis to the liver and clinical presentation mimicking fulminan t hepatic failure. The patient was a 69-year-old man admitted to the h ospital for upper gastrointestinal hemorrhage. Two years previously he had undergone a right nephrectomy for urothelial carcinoma (T2, GII). After five days of hospital admission, he developed progressive jaund ice, ascites, deteriorating mental status with high serum enzyme activ ities (AST, ALT, LDH, alkaline phosphatase) and death 20 days after ho spitalization. No grossly detectable hepatic metastatic nodules were d emonstrated. A percutaneous postmortem liver biopsy revealed a diffuse infiltration of tumor cells into the hepatic sinusoids and venous inv asion.