Liver failure due to metastatic melanoma: A case report

Abstract

Background: Acute liver failure (ALF) due to diffuse hepatic infiltration by metastatic melanoma is extremely rare and often misdiagnosed. In the absence of prior malignancy, this presentation can mimic other hepatic emergencies such as Budd-Chiari syndrome. Early identification is crucial, especially in transplant candidates, to prevent inappropriate management.

Case summary: A 61-year-old male presented with jaundice, abdominal distension, and encephalopathy. Liver imaging suggested acute Budd-Chiari syndrome, and liver transplantation was considered. However, biopsy revealed extensive hepatic infiltration by human melanoma black-positive melanoma cells. There was no known cancer history, although retrospective symptoms suggested uveal localization as a possible primary site. The patient rapidly deteriorated and died. A review of 12 similar cases revealed shared diagnostic challenges, frequent misdiagnoses, and poor outcomes.

Conclusion: Infiltrative melanoma should be considered in unexplained ALF, even without previously known malignancy.

Keywords: Acute liver failure; Budd-Chiari syndrome; Case report; Hepatic infiltration; Melanoma.

Figure 1

Ultrasound examination. A: Marked hepatomegaly with multiple hypervascular lesions in the liver; B: Sagittal section showing hepatomegaly, thrombus in the left hepatic vein (arrow), with absence of the right and middle hepatic veins; C: Sagittal section showing hepatomegaly and thrombus in the left hepatic vein.

Figure 2

Microscopic view shows a sparse amount of normal liver parenchyma, with the remainder of the biopsy consisting of a necrotic tumor infiltrate composed of clusters and short strands of atypical, oval to spindle-shaped cells, with polymorphic nuclei and prominent nucleoli. Arrows are pointing to the tumor cells.

Figure 3

Immunohistochemical analysis of liver biopsy. A: Human melanoma black; B: Cytokeratin AE1/AE3; C: Discovered On Gastrointestinal Stromal Tumor 1.