Liver Cell Adenoma Associated with Membranous Nephropathy

M.J. Coma-del-Corral, Servicio de Anatomía Patológica, Hospital General Yagüe, Avenida del Cid s/n, E-09005 Burgos (Spain) Dear Sir, Membranous glomerulonephritis is a renal injury caused by immune complexes, among which different antigens associated with tumors have been implicated; most of them are carcinomas. Another, less numerous group corresponds to malignant hematologic diseases [1–3]. Very rarely, benign neoplasms have been reported to be associated with this condition. There are also cases of liver carcinoma with or without HBAg [4, 5], but up to now, we have not found associations between liver cell adenoma and nephropathy. The membranous nephropathy is characterized by discontinuous deposits of immunoglobulins and complement exclusively in subepithelial distribution along the outer surface of the glomerular capillary wall. A 62-year-old man who was admitted to hospital with dyspneic cough, blood-stained sputum and pain in the right hemithorax. He had malaise, anorexia and weight loss for 1 month. On examination, there were diminished breath sounds in the lower and posterior right thorax; the liver edge was palpable 4 cm below the costal margin; the patient also had malleolar swelling. Xray of the chest showed right pleural effusion. The laboratory findings were as follows: serum protein 5.6 g/dl, albumin 1.69 g/dl and α2 globulin 1.145 g/dl (20.44%). Immunoglobulins: IgG 1,250 mg/dl, IgA 419 mg/dl and IgM 145 mg/dl. CEA, α-fetoprotein, HBsAg and HBsAc were all negative. The results of the urine test were: proteins 12.4 g/24 h. No other abnormal substance was found. Urinary sediment was normal. As a secondary nephropathy was suspected, an echography was carried out; which revealed a solid growth in the right hepatic lobe; the tumor was hyperechogenic, irregular in shape with hypodense areas inside and arterial supply coming from the hepatic artery. These findings were confirmed by laparoscopy. In view of the relatively good general condition of the patient, the precise diagnosis made, the antecedents of pulmonary embolism and the possibility to resect the mass, a laparotomy was indicated. A few hours before surgery was due to take place, the patient began to suffer from another dyspneic crisis and hypertension, followed by loss of consciousness, cyanosis and cardiorespiratory arrest, which could not be overcome. At autopsy, a massive pulmonary embolism and renal vein thrombosis