Acute liver failure caused by metastatic malignant melanoma of liver

Abstract

Abstract Introduction: Malignant melanoma of liver is an exceedingly rare cause of acute liver failure (ALF), whether primary or metastatic. Only few cases have been reported in the worldwide literature, and all the patients with ALF secondary to diffuse hepatic infiltration by melanoma subsequently died within days. Patient concerns: The patient was a 70-year-old man admitted to our hospital for abdominal distention and progressive jaundice for 15 days. Diagnoses: Ultrasonography and computed tomography findings indicated the presence of hepatomegaly with homogeneous normal echogenicity without focal lesions. Due to the history of alcohol consumption, acute liver failure (ALF) caused by alcoholic live disease was suspected. Interventions: After 4 time artificial liver treatment, the patient continued to deteriorate and deceased donor liver transplantation was performed after discussion with the next-of-kin. Outcomes: Postoperative pathology revealed clusters of malignant melanoma cells that had diffusely infiltrated the liver parenchyma. The patient was discharged on the eleventh day post-operation. Three months post-transplantation, he was readmitted because of elevated liver enzymes, and died of acute liver failure 9 days later. Conclusions: To our knowledge, this is the first report of liver transplantation for ALF due to diffuse hepatic melanoma. When the etiology of liver failure is unclear, diffuse metastatic tumor infiltration should be considered and early liver biopsy would be helpful in establishing the diagnosis and guiding treatment, particularly when liver transplantation is a treatment option as a metastatic malignancy is a contraindication for liver transplantation.