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A 72-year-old woman had a six-month history of upper abdominal swelling, pain in the right upper quadrant, weight loss of 13.6 kg (30 lb), anorexia, and generalized weakness. Laboratory analysis revealed an alkaline phosphatase level of 259 U per liter, a lactate dehydrogenase level of 559 U per liter, an aspartate aminotransferase level of 129 U per liter, and a bilirubin level of 1.4 mg per deciliter (24 µmol per liter). A computed tomographic (CT) scan of the abdomen showed multiple hepatic metastases (arrows). Until eight months before presentation, she had smoked an average of 1 1/2 packs of cigarettes . . . [Full Text of this Article] |