28296775 Visualization

A 78 Age - year Age - old Age previously History healthy History male Sex heavy History smoker History presented Clinical_event at the Emergency Nonbiological_location Department Nonbiological_location with generalized Detailed_description jaundice Sign_symptom ( sclera Biological_structure and skin Biological_structure ), ascites Sign_symptom , and hepatic Disease_disorder coma Disease_disorder .
The relatives declared that he was known to have a urinary Disease_disorder bladder Disease_disorder carcinoma Disease_disorder that was diagnosed at a routine control performed 3 Date months Date before Date but no medical papers to prove this diagnosis were shown.
They also mentioned a 2 Duration - month Duration history of progressive Detailed_description jaundice History , somnolence History , and temporary Detailed_description loss History of History consciousness History .
No weight Sign_symptom loss Sign_symptom or other clinical signs were mentioned.
No previously viral Disease_disorder hepatitis Disease_disorder or drug Clinical_event excess Clinical_event was reported.
No Family_history family Family_history history Family_history of Family_history cancer Family_history was declared.
At the present admission, the abdominal Biological_structure CT Diagnostic_procedure scan Diagnostic_procedure showed marked hepatomegaly Sign_symptom with multiple Detailed_description small Detailed_description nodules Sign_symptom (2–10  mm Distance in diameter) that was supposed to be hepatic Biological_structure metastases Sign_symptom from the bladder Disease_disorder carcinoma Disease_disorder .
The thoracic Biological_structure x Diagnostic_procedure - ray Diagnostic_procedure showed a bilateral Detailed_description bronchopneumonia Sign_symptom without abnormal Lab_value opacities Sign_symptom .
The patient died Clinical_event with hepatic Disease_disorder encephalopathy Disease_disorder at 7 Time   hours Time after Time admission.
Prior to the autopsy Diagnostic_procedure , signed informed consent of the relatives was obtained for the case publication.
Being about a case report, no Ethical Committee approval was necessary.
At autopsy, the macroscopic Diagnostic_procedure examination Diagnostic_procedure showed a huge Lab_value liver Diagnostic_procedure ( 6.5 Mass kg Mass ) with widely Detailed_description distributed Detailed_description white Color nodules Sign_symptom of varying Detailed_description sizes Detailed_description (Fig.1).
The urinary Diagnostic_procedure bladder Diagnostic_procedure was not Lab_value modified Lab_value , but a 30 Volume × Volume 30 Volume × Volume 50 Volume   mm Volume prostate Biological_structure nodule Sign_symptom with infiltrative Detailed_description aspect Detailed_description was observed (Fig.2).
The bilateral Detailed_description bronchopneumonia Sign_symptom was confirmed, without any central Detailed_description tumor Sign_symptom mass Sign_symptom .
A 10 Distance - mm Distance white Color nodule Sign_symptom was identified encasing a small Biological_structure bronchus Biological_structure from the middle Biological_structure lobe Biological_structure of Biological_structure the Biological_structure right Biological_structure lung Biological_structure , without peripheral Sign_symptom nodules Sign_symptom (Fig.3).
Except for moderate Severity edema Sign_symptom , no other brain Biological_structure lesions Sign_symptom were identified.
The other Biological_structure organs Biological_structure did not show modifications Sign_symptom .
The tissues were fixed in 10% neutral formalin and embedded in paraffin together with iliac crest bone grafting.
Microscopic Diagnostic_procedure examination Diagnostic_procedure of the prostate Biological_structure showed a 3+3 Diagnostic_procedure Gleason's Diagnostic_procedure grade Diagnostic_procedure 2 Lab_value occult Detailed_description adenocarcinoma Disease_disorder (Fig.2).
Clusters and sheets of small round cells were seen in the liver parenchyma (Fig.1) and the lymph nodes from the hepatic hilum.
Examination of the lung parenchyma showed a peribronchial Biological_structure SCLC Disease_disorder with multiple Detailed_description tumor Sign_symptom emboli Sign_symptom in both veins Biological_structure and lymphatic Biological_structure vessels Biological_structure and multiple “ coin Shape - shaped Shape ” tumor Sign_symptom nodules of 1 Distance to Distance 2 Distance   mm Distance in diameter below Biological_structure the Biological_structure pleura Biological_structure (Fig.3).
The small round tumor cells were also seen in bone marrow from the iliac crest bone (Fig.3).
No brain Biological_structure metastases Sign_symptom have been detected.
Based on the macro- and microscopic features and clinical picture, the final diagnosis was “ peribronchial Biological_structure and coin Shape - like Shape peripheral Detailed_description SCLC Disease_disorder with massive Severity angiolymphatic Biological_structure invasion Disease_disorder and metastases Sign_symptom in the lymph Biological_structure nodes Biological_structure , liver Biological_structure and bone Biological_structure , associated with encephalopathy Disease_disorder and synchronous Detailed_description occult Detailed_description adenocarcinoma Disease_disorder of the prostate Biological_structure .”