Acute Liver Failure Secondary to Hepatic Infiltration of Malignant Melanoma

Abstract

Acute liver failure due to malignant melanoma is uncommon. We presents a case of acute liver failure secondary to hepatic infiltration of a malignant melanoma. An 86-year-old man was admitted with elevated liver enzymes and an increased lactate dehydrogenase level. His condition progressed to acute liver failure, but the etiology of liver failure was unclear. Esophagogastroduodenoscopy was performed to evaluate dyspepsia, which showed signs indicative of malignant melanoma. Based on the endoscopy findings and elevated liver enzyme levels, liver biopsy was performed to confirm the presence of malignant melanoma. Hepatic infiltration of malignant melanoma was observed histologically. However, massive and diffuse liver metastasis is very rare and difficult to identify on imaging studies. If the etiology of liver failure is unclear, diffuse metastatic melanoma infiltration should be considered as differential diagnosis. Early liver biopsy can help to clarify the diagnosis.

Keywords: Acute liver failure; Hepatic infiltration; Liver biopsy; Malignant melanoma.

Fig. 1.

Computed tomography scan shows mild fatty change and small amount of ascites without focal lesions in the liver.

Fig. 2.

Endoscopic findings. (A), (B) Multiple black pigmented spots and nodules are seen on the entire stomach. (C) A round deep ulcer with black pigmented base is seen at the lesser curvature of the antrum. (D) Multiple shallow ulcers with black pigmented base are seen in the duodenum.

Fig. 3.

Magnetic resonance imaging shows multiple high signal intensity nodules without defined focal mass-like lesions in the liver on T2 blade.

Fig. 4.

Stomach biopsy findings. (A) Stomach biopsy findings show nucleoli with distinct large nucleus and infiltrating tumor cells with brown pigmentation (hematoxylin & eosin stain, ×200). (B, C, D) Immunohistochemically, the tumor cells are positive for S-100, HMB45, and melan-A (immuhohistochemical stain, ×100).

Fig. 5.

(A, B) Liver biopsy results show nucleoli with distinct large nucleus and infiltrating tumor cells with brown pigmentation (hematoxylin & eosin stain, ×100 and ×200).

Fig. 6.

(A) The right second toenail color changed to black beyond the nail fold. (B) A brown spot with an irregular border and shape was found on the lower leg.