Klinische Wochenschrift

, Volume 67, Issue 11, pp 592–597 | Cite as

Multiple nodular foci in the liver associated with chronic hepatic porphyria after previous treatment of breast cancer

  • W. K. Lelbach
  • T. R. Müller
  • W. Kersjes
  • J. H. Hartlapp
  • M. Doss
Kasuistiken

Summary

More than 7 years after the diagnosis and treatment of breast cancer (T1N1aM0), multiple nodular foci were observed in the liver of a 40-year-old woman at ultrasonographic examination. The lesions were confirmed by CT scan, but CT-guided liver biopsy revealed only non-specific alterations. At subsequent peritoneoscopic examination, bluish-brown foci were indeed visible on the liver surface, but guided liver biopsies again failed to corroborate the suspected metastases. Instead, histology showed mild portal fibrosis, moderate steatosis and siderosis of hepatocytes, as before. Only the intense red fluorescence of part of the biopsy material under Wood's light suggested the diagnosis of chronic hepatic porphyria or porphyria cutanea tarda, here presumably as a consequence of prolonged alcohol consumption. Subsequent porphyrin studies in urine, faeces and plasma yielded the typical constellation of latent porphyria cutanea tarda (chronic hepatic porphyria type C). The activity of erythrocyte uroporphyrinogen decarboxylase was normal, which argued against a genetic predisposition. After 1 year of strict alcohol abstinence and low-dose chloroquine treatment the “nodular foci” in the liver were no longer visible on ultrasonogram and CT scan; only proton-weighted NMR imaging (SE 1500/30) still showed ill-defined areas of higher signal intensity. The renal excretion of porphyrins had decreased considerably. The levels are now consistent with the diagnosis of subclinical chronic hepatic porphyria type A. Modern non-invasive imaging techniques are tremendously useful, but they have their pitfalls. Focal liver lesions may present serious diagnostic problems, especially when they are found in a patient with a history of carcinoma at an extrahepatic primary site. A rare example is described.

Key words

Breast cancer Chronic hepatic porphyria Focal liver lesions 

Abbreviations

gamma-GT

gamma glutamyl transpeptidase

CEA

carcinoembryonic antigen

CA-15-3

breast cancer associated antigen

TPA

tissue polypeptide antigen

CHP

chronic hepatic porphyria

PCT

porphyria cutanea tarda

delta-ALA

delta-amino-laevulinic acid

CT

computerised axial tomography

NMR

nuclear magnetic resonance

T1, T2

relaxation time

TE

echo time

TR

repetition time

SE

spin echo

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Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • W. K. Lelbach
    • 1
  • T. R. Müller
    • 1
  • W. Kersjes
    • 2
  • J. H. Hartlapp
    • 1
  • M. Doss
    • 3
  1. 1.Medizinische Klinik der Universität BonnGermany
  2. 2.Radiologische Klinik der Universität BonnGermany
  3. 3.Abteilung für Klinische Biochemie der Universitätsklinik MarburgGermany

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