An Autopsy Case of Diffuse Liver Metastasis of Small Cell Lung Cancer with Rapid Liver Injury Diagnosed by FDG-PET/CT Before Death

<p>Background. Diffuse liver metastases are often not detected by computed tomography (CT) or ultrasonography and are rarely diagnosed before death. In this report, we describe a case in which diffuse liver metastasis of small cell lung cancer (SCLC) caused rapidly progressive liver dysfunction, which was diagnosed before death by fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) and confirmed at autopsy. Case. A 58-year-old woman was referred to the Department of Gastroenterology in October of year X with a chief complaint of upper abdominal and back pain that had persisted for several months. A CT scan revealed a 37 mm tumor lesion in the left pulmonary hilar region and hepatomegaly. A bronchoscopic lung biopsy disclosed small cell carcinoma. An FDG-PET/CT scan showed diffuse FDG accumulation in the liver as well as in the thoracolumbar vertebral body, leading to a stage diagnosis of cT3N3M1c c-Stage IVB. At the time of the first visit, she was in good general condition, and chemotherapy was planned to be introduced. However, three days after the bronchoscopy, she was transported to the hospital due to rapid deterioration of her general condition and jaundice. She died of liver failure 12 days after her first visit. The autopsy revealed SCLC in the left pulmonary hilum and vertebral body, and in the liver, almost no normal parenchymal cells were found, which were replaced by numerous nodular metastases. Conclusion. We report a case in which diffuse liver metastasis of SCLC was diagnosed by FDG-PET/CT before death, but the patient died due to rapid deterioration of the liver function.</p>