An autopsy case of lung metastasis of hepatocellular carcinoma with severe empyema during administration of lenvatinib

Abstract

An 80-year-old woman with previous history of hepatic segmentectomy for HCC, had a recurrence in the right lung over five years after her follow up. She received radiation therapy, followed by lenvatinib administration (8 mg/day). 54 days after the initiation of lenvatinib, she complained of dyspnea. The laboratory examination showed elevated inflammatory parameters, and her chest X-ray revealed right pleural effusion. Gram-positive cocci were detected by fluid culture, and the diagnosis of empyema was confirmed. Although the administration of antibiotics and continuous chest fluid drainage had been started, she developed ARDS and finally died from respiratory failure. The autopsy revealed disruption of the pleura connected to the necrotic metastatic lesion in the right lung, indicating that empyema occurred subsequent to tumor necrosis induced by lenvatinib. We report this rare case with a pleural complication after the treatment with lenvatinib to HCC.