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Sweed D, Sultan MM, Mosbeh A, Fayed YA, Abdelsameea E, Ehsan NA, Abdel-Rahman MH, Waked I. Lymphoepithelioma-like Hepatocellular Carcinoma: a Case Report and Review of Literature. J Gastrointest Cancer 2021; 54:275-281. [PMID: 34813031 DOI: 10.1007/s12029-021-00757-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 01/07/2023]
Abstract
We report a case of hepatic lymphoepithelioma-like carcinoma-hepatocellular carcinoma subtype (LEL-HCC) in a 41-year-old man with chronic hepatitis C virus (HCV) infection. The patient presented with abdominal pain and further assessment revealed a hypoechoic mass on ultrasonography. Serum alpha-fetoprotein (AFP) was 13·6 ng/dl. The patient was diagnosed as hepatocellular carcinoma based on the established triphasic computed tomography (TCT) diagnostic criteria and he underwent a surgical resection of the mass. Microscopic examination showed sheets and cords of malignant epithelial cells intermixed with heavy lymphoid infiltrate, with more than 100 tumor-infiltrating lymphocytes (TILs) per 10 high-power-field (HPF). Based on immunohistochemical studies, the malignant cells were positive for Hep Par 1 and glypican 3, focally positive for cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20). TILs were diffusely positive for cluster of differentiation 3 CD3 with an approximately equal CD4/CD8 ratio. The patient was recurrence free at 25 months after surgery, as evident by CT and serum alpha-fetoprotein level. LEL-HCC is a rare variant of HCC with a relatively better prognosis. Exploring the potential for immune modulator-based therapy in this subset of tumors is highly recommended.
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Affiliation(s)
- Dina Sweed
- Pathology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
| | - Mervat M Sultan
- Pathology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
| | - Asmaa Mosbeh
- Pathology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt.
| | - Yahya A Fayed
- Hepatopancreatobiliary Surgery Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
| | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
| | - Nermine A Ehsan
- Pathology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
| | - Mohamed H Abdel-Rahman
- Pathology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
| | - Imam Waked
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt
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2
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Omori G, Osuga T, Miyanishi K, Hamaguchi K, Tanaka S, Ohnuma H, Murase K, Takada K, Nagayama M, Kimura Y, Takemasa I, Kikuchi Y, Torigoe T, Kato J. Programmed cell death ligand 1 expression in a case of poorly differentiated lymphocyte-rich hepatocellular carcinoma. Clin Case Rep 2021; 9:e04764. [PMID: 34522383 PMCID: PMC8428809 DOI: 10.1002/ccr3.4764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022] Open
Abstract
Our pathological study of a case of poorly differentiated lymphocyte-rich hepatocellular carcinoma suggested that immune checkpoint inhibitor may be an effective therapy. The histological type is an important factor in determining treatment choices.
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Affiliation(s)
- Ginji Omori
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Takahiro Osuga
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Koji Miyanishi
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Kota Hamaguchi
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Shingo Tanaka
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
- Department of Infection Control and Laboratory MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Hiroyuki Ohnuma
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Kazuyuki Murase
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Kohichi Takada
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Minoru Nagayama
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical University School of MedicineSapporoJapan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical University School of MedicineSapporoJapan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical University School of MedicineSapporoJapan
| | - Yasuhiro Kikuchi
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Toshihiko Torigoe
- Department of PathologySapporo Medical University School of MedicineSapporoJapan
| | - Junji Kato
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
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3
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The CT and MRI Features of Primary Intrahepatic Lymphoepithelioma-Like Cholangiocarcinoma. AJR Am J Roentgenol 2020; 216:393-402. [PMID: 33325732 DOI: 10.2214/ajr.20.22937] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE. The purpose of our study was to retrospectively characterize the CT and MRI features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). MATERIALS AND METHODS. Eleven patients (10 women and one man; age range, 30-63 years) with 11 pathologically proven LELCCs were enrolled retrospectively from April 2016 to December 2018. Triphasic enhanced images were obtained of all patients: MR images of five patients, CT images of five patients, and both CT and MR images of one patient. The clinical data and CT and MRI findings were reviewed. RESULTS. All LELCC cases were associated with Epstein-Barr virus (EBV) infection. Eight of the 11 patients had hepatitis B virus (HBV) infection. The tumor diameter ranged from 1.1 to 8.7 cm. All tumors were well defined with a smooth or lobulated margin. A cystic area was noted in two of the 11 tumors. After the administration of contrast material, the tumors showed homogeneous (n = 7) or heterogeneous (n = 4) hypervascular arterial enhancement and gradual washout, delayed central scar or irregular enhancement (n = 9), delayed circular thin or incomplete pseudocapsule enhancement (n = 7), and homogeneous hypointensity in the hepatobiliary phase (n = 2). No cirrhosis, focal dilatation of intrahepatic ducts, or satellite nodules were detected. Lymphadenopathy were detected in four patients, appearing as hypervascular enhancement and no necrosis (even in multiple nodes > 3 cm) or as moderate peripheral enhancement and necrosis. CONCLUSION. A liver mass in a middle-aged woman with EBV and HBV infection that appears on CT and MRI to have a well-defined boundary and a combination of hypervascularity, washout, delayed intratumoral enhancement, or pseudocapsule enhancement may suggest an imaging diagnosis of primary LELCC. More cases are needed to better understand this disease.
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Zhang K, Tao C, Tao Z, Wu F, An S, Wu J, Rong W. Lymphoepithelioma-like carcinoma in liver not associated with Epstein-Barr virus: a report of 3 cases and literature review. Diagn Pathol 2020; 15:115. [PMID: 32967689 PMCID: PMC7513497 DOI: 10.1186/s13000-020-01035-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Lymphoepithelioma-like carcinoma is a rare distinctive variant of liver cancer with unique epidemiological and pathological characteristics, characterized by dense lymphocyte infiltration. It can be divided into lymphoepithelioma-like hepatocellular carcinoma and lymphoepithelioma-like intrahepatic cholangiocarcinoma. Existing research shows that the prognosis of this tumor is good. To date, only 101 cases have been reported. Case presentation The first patient was a 62-year-old Chinese man with hepatitis B virus infection who presented with a single lesion in the liver. The patient underwent surgical treatment and was discharged on the 4th day. The patient was diagnosed with combined lymphoepithelioma-like hepatocellular carcinoma and cholangiocarcinoma; he has been alive for 15 months. The second patient was a 63-year-old Chinese woman with right upper abdominal pain and hepatitis B virus infection. The imaging examination revealed a single lesion in the liver. The patient underwent surgical treatment and was discharged 1 week later. The patient was diagnosed with lymphoepithelioma-like hepatocellular carcinoma and was considered to have recurrence in the lymph nodes approximately 2 years after the operation. The patient underwent local radiotherapy; she has been alive for 60 months. The third patient was a 50-year-old Chinese man with hepatitis B virus infection who presented with a single lesion in the liver and two enlarged lymph nodes. The patient received liver puncture before surgery to indicate lymph node metastasis and experienced local recurrence after liver resection. The patient underwent chemotherapy and radiotherapy. The patient was diagnosed with lymphoepithelioma-like hepatocellular carcinoma. The patient was deceased at 24-month follow-up. Conclusions This article reports 3 cases without Epstein-Barr virus and reviews the current literature, which suggests even mixed pathological type or locally advanced cases of LELC with lymph node metastasis and postoperative recurrence should be actively treated for a longer survival period.
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Affiliation(s)
- Kai Zhang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Changcheng Tao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zonggui Tao
- Department of Imaging, Jinan city people's hospital, Shandong First Medical University, Jinan, 271199, China
| | - Fan Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Songlin An
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Jianxiong Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Weiqi Rong
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Noguchi H, Noguchi N, Idichi T, Kawasaki Y, Kirishima M, Tasaki T, Kitazono I, Horinouchi M, Hiraki T, Higashi M, Tanimoto A. Case report of a lymphoepithelioma-like hepatocellular carcinoma with prominent lymphoplasmacytic infiltration. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee J, Lee N, Yoon HK, Lee YJ, Park SJ. Cystic Degeneration of Hepatocellular Carcinoma Mimicking Mucinous Cystic Neoplasm. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:303-307. [PMID: 31132829 DOI: 10.4166/kjg.2019.73.5.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/03/2022]
Abstract
Spontaneous regression of tumors is an extremely rare event in hepatocellular carcinoma (HCC) with only a few reports available. With the accumulation of clinical information and tumor immunogenetics, several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of the partial regression of HCC, which was initially misdiagnosed as a mucinous cystic neoplasm of the liver due to the unusual radiologic findings. A 78-year-old female with the hepatitis B virus and liver cirrhosis presented with an approximately 5 cm-sized cystic mass of the liver. From the radiologic evidence of a papillary-like projection from the cyst wall toward the inner side, the initial impression was a mucinous cystic neoplasm of the liver. The patient underwent a surgical resection and finally, cystic degeneration of HCC, in which approximately 80% necrosis was noted. This case suggests that if a cystic neoplasm of liver appears in a patient with a high risk of HCC on a hepatobiliary imaging study, it is prudent to consider the cystic degeneration of HCC in a differential diagnosis.
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Affiliation(s)
- Jangwon Lee
- Departments of Gastroenterology and Hepatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Namhee Lee
- Departments of Gastroenterology and Hepatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hye Kyoung Yoon
- Departments of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yeon Jae Lee
- Departments of Gastroenterology and Hepatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Jae Park
- Departments of Gastroenterology and Hepatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.,Paik Institute for Clinical Research, Busan, Korea
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Very Rare Liver Neoplasm: Lymphoepithelioma-Like ( LEL) Hepatocellular Carcinoma. Case Rep Pathol 2018; 2018:2651716. [PMID: 30258661 PMCID: PMC6146624 DOI: 10.1155/2018/2651716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/27/2018] [Accepted: 08/26/2018] [Indexed: 12/13/2022] Open
Abstract
A case of lymphoepithelioma-like (LEL) hepatobiliary carcinoma is reported. To date, only 89 cases of this rare neoplasm have been reported, with both hepatocellular and cholangiocellular histotype. The case reported here could be classified as LEL mixed hepatobiliary carcinoma (Hepato-Cholangio), a histotype not reported so far in the LEL variant.
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8
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Wang JK, Jin YW, Hu HJ, Regmi P, Ma WJ, Yang Q, Liu F, Ran CD, Su F, Zheng EL, Li FY. Lymphoepithelioma-like hepatocellular carcinoma: A case report and brief review of literature. Medicine (Baltimore) 2017; 96:e9416. [PMID: 29390565 PMCID: PMC5758267 DOI: 10.1097/md.0000000000009416] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONAL Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is a rare variant of hepatocellular carcinoma (HCC). To date, few cases have been reported in the literature, and almost no report in analyzing the different features of LEL-HCC. PATIENT CONCERNS We describe a 37-year-old female patient with a 32 × 30 mm mass in the right liver. INTERVENTIONS Complete surgical resection of the lesion was performed. DIAGNOSES Histopathological examination of the resected tumor revealed undifferentiated HCC cells with significant lymphocytes infiltration. Immunohistochemically, the tumor cells were positive for AFP (alpha fetoprotein), hepatocyte, CK8, and glypican-3. The patient was diagnosed with LEL-HCC. OUTCOMES The patient had a favorable clinical outcome, and was free from tumor recurrence after a 52-months follow-up. LESSONS Our case was the youngest patient of all the reported cases, and the third case who was infected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). LEL-HCC is a rare variant of HCC, with a relatively favorable prognosis. Further research recruiting more patients is required to determine the accurate causes and mechanism of LEL-HCC.
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Affiliation(s)
| | | | | | | | | | | | - Fei Liu
- Department of Biliary Surgery
| | | | | | - Er-Liang Zheng
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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9
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Labgaa I, Stueck A, Ward SC. Lymphoepithelioma-Like Carcinoma in Liver. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:1438-1444. [PMID: 28500863 DOI: 10.1016/j.ajpath.2017.02.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/27/2017] [Indexed: 02/07/2023]
Abstract
Liver cancer, primarily encompassing hepatocellular carcinoma and intrahepatic cholangiocarcinoma, has become the second leading cause of worldwide cancer-related death during the past two decades. Lymphoepithelioma-like carcinomas (LELCs) are defined as tumors composed of undifferentiated epithelial cells with a prominent lymphoid infiltrate, and can arise in the liver as hepatocellular or cholangiocarcinoma forms. Patients with liver LELC display distinctive demographics and tumor characteristics. LELCs also appear to be associated with strikingly better outcomes compared to typical liver cancers, with 5-year survival rates of 57% to 100% versus 12% to 68%, respectively. Liver LELCs represent a unique model of immune response in liver cancer. Data on LELCs of the liver remain limited, and future comprehensive studies are needed to further elucidate this disease, which could ultimately offer precious insights for immunotherapeutic strategies in liver cancer.
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Affiliation(s)
- Ismail Labgaa
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Ashley Stueck
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephen C Ward
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.
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10
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Kim SB, Kang W, Shin SH, Lee HS, Lee SH, Choi GH, Park JY. Spontaneous neoplastic remission of hepatocellular carcinoma. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 65:312-5. [PMID: 25998978 DOI: 10.4166/kjg.2015.65.5.312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7 × 3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient.
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11
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Insilla AC, Faviana P, Pollina LE, Simone PD, Coletti L, Filipponi F, Campani D. Lymphoepithelioma-like hepatocellular carcinoma: Case report and review of the literature. World J Gastroenterol 2015; 21:10468-10474. [PMID: 26420974 PMCID: PMC4579894 DOI: 10.3748/wjg.v21.i36.10468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/29/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here, a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy, the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2, CK8, CK18, CEA (polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3, CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors (GISTs). The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here, we report the clinicopathological features of our case, along with a review of the few cases present in the literature.
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MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biopsy, Needle
- Carcinoma, Hepatocellular/chemistry
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Carcinoma, Hepatocellular/virology
- Epithelial Cells/chemistry
- Epithelial Cells/pathology
- Female
- Gastrointestinal Stromal Tumors/pathology
- Hepatectomy
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/diagnosis
- Humans
- Immunohistochemistry
- Liver Neoplasms/chemistry
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Neoplasms/virology
- Lymphocytes/chemistry
- Lymphocytes/pathology
- Neoplasms, Multiple Primary
- Stomach Neoplasms/pathology
- Tomography, X-Ray Computed
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Yang SZ, Zhang W, Yuan WS, Dong JH. Recurrence of Hepatocellular Carcinoma With Epithelial-Mesenchymal Transition After Spontaneous Regression: A Case Report. Medicine (Baltimore) 2015; 94:e1062. [PMID: 26181539 PMCID: PMC4617070 DOI: 10.1097/md.0000000000001062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most malignant cancers and ranks as the third leading cause of cancer-related death in the world. However, some patients with untreated HCC can experience spontaneous regression, a rare phenomenon that has been observed in various malignancies. Here, we report a unique case with untreated HCC, who first underwent a spontaneous cancer regression after the spontaneous clearing of chronic hepatitis B virus (HBV) infection from the liver as evidenced by hepatitis B virus surface antigen (HBsAg) seroconversion; then developed the recurrent HCC with epithelial-mesenchymal transition (EMT) after 14 years. We hypothesized that a strengthened immune system in response to HBV infection may have led to immune-mediated spontaneous cancer regression. The later recurrence of HCC may suggest the host's immune system was no longer able to contain HCC since aging and other chronic diseases may have significantly weakened the immune surveillance.
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Affiliation(s)
- Shi-zhong Yang
- From the Department of Hepatobiliary Surgery (Yang SZ, Yuan WS); Department of Pathology (Zhang W), 401 Hospital of PLA, Qingdao; and Department of Hepatobiliary Surgery (Dong JH), Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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13
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Solinas A, Calvisi DF. Lessons from rare tumors: Hepatic lymphoepithelioma-like carcinomas. World J Gastroenterol 2015; 21:3472-3479. [PMID: 25834311 PMCID: PMC4375568 DOI: 10.3748/wjg.v21.i12.3472] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/11/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
In this review we focus on lymphoepithelioma-like hepatocellular carcinomas (LEL-HCC) and lymphoepithelioma-like cholangiocarcinomas (LEL-ICC). Despite their rarity, these tumors are of general interest because of their epidemiological and clinical features, and because they represent a distinct model of interaction between the immune system and neoplastic cells. Approximately half of LEL-HCC arise in the context of chronic hepatitis C virus (HCV) infection and have been described both in Eastern and Western patients. By contrast, LEL-ICC is associated in almost all cases with Epstein-Barr virus (EBV) infection and exhibits the same epidemiological features of EBV related malignancies. Compared with classical hepatocellular carcinoma and intrahepatic cholangiocarcinoma of corresponding stage, both LEL-HCC and LEL-ICC are characterized by lower rates of recurrence after surgery and better overall survival. How this behavior is related to distinct genetic alterations and tumor microenvironment is unclear. The pathophysiological mechanisms of lymphoid infiltrations seem to be different among the two groups of tumors. In fact, LEL-HCC frequently arises in the context of inflammatory changes driven by HCV infection, and has been recognized as a variant of classical hepatocellular carcinoma. At variance, lymphocyte recruitment of LEL-ICC is similar to that described in nasopharyngeal carcinoma and gastric LEL, and possibly depends on the expression pattern of latent EBV infection.
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Patel KR, Liu TC, Vaccharajani N, Chapman WC, Brunt EM. Characterization of inflammatory (lymphoepithelioma-like) hepatocellular carcinoma: a study of 8 cases. Arch Pathol Lab Med 2014; 138:1193-202. [PMID: 25171701 DOI: 10.5858/arpa.2013-0371-oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT The World Health Organization has recently recognized lymphoepithelioma-like carcinoma, or inflammatory hepatocellular carcinoma, as a variant of hepatocellular carcinoma. OBJECTIVE To identify and characterize the inflammatory hepatocellular carcinomas in our institution from 1988 to the present. DESIGN All cases of hepatocellular carcinoma in our institution from 1988 to the present were reviewed and reclassified as lymphoepithelioma-like carcinoma and were studied in comparison to appropriately matched controls. RESULTS Among the 8 cases of lymphoepithelioma-like carcinoma identified, the male to female ratio was 1:3, the mean age was 68.5 years (range, 57-78 years), and all of the cases were seen in noncirrhotic livers. The average numbers of lymphocytes were significantly higher in the cases than in the controls. T cells were predominant, with a uniform distribution of CD4 and CD8 positive cells. Cholangiolar differentiation was seen by K19 positivity as focal in 1 case and diffuse in 2 cases. In situ hybridization for Epstein-Barr virus was negative in all of the cases. Diffuse overexpression of p16 (>75% of cells) was seen in 2 cases, both of which were negative for the presence of transcriptionally active human papilloma virus by in situ hybridization. In our series, 3 of 8 cases (37.5%) showed local recurrence, which was similar to the controls (6 of 18; 33%), P > .99. Although the rate of distant metastases was lower among the cases (12.5%) than the controls (22.2%), the difference was not statistically significant (P > .99). CONCLUSION We present the first series of 8 cases of lymphoepithelioma-like carcinoma of the liver occurring in patients without cirrhosis and with a female preponderance and the absence of Epstein-Barr virus. Although clinical outcomes were similar to those of controls in our small series, additional data may be required for confirmation.
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Affiliation(s)
- Kalyani R Patel
- From the Department of Laboratories, Seattle Children's Hospital, Seattle, Washington (Dr Patel); and the Departments of Pathology and Immunology (Drs Liu and Brunt) and Surgery (Drs Vaccharajani and Chapman), Washington University in St Louis, St Louis, Missouri
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15
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Schlageter M, Terracciano LM, D’Angelo S, Sorrentino P. Histopathology of hepatocellular carcinoma. World J Gastroenterol 2014; 20:15955-15964. [PMID: 25473149 PMCID: PMC4239483 DOI: 10.3748/wjg.v20.i43.15955] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/09/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is currently the sixth most common type of cancer with a high mortality rate and an increasing incidence worldwide. Its etiology is usually linked to environmental, dietary or life-style factors. HCC most commonly arises in a cirrhotic liver but interestingly an increasing proportion of HCCs develop in the non-fibrotic or minimal fibrotic liver and a shift in the underlying etiology can be observed. Although this process is yet to be completely understood, this changing scenario also has impact on the material seen by pathologists, presenting them with new diagnostic dilemmas. Histopathologic criteria for diagnosing classical, progressed HCC are well established and known, but with an increase in detection of small and early HCCs due to routine screening programs, the diagnosis of these small lesions in core needle biopsies poses a difficult challenge. These lesions can be far more difficult to distinguish from one another than progressed HCC, which is usually a clear cut hematoxylin and eosin diagnosis. Furthermore lesions thought to derive from progenitor cells have recently been reclassified in the WHO. This review summarizes recent developments and tries to put new HCC biomarkers in context with the WHOs reclassification. Furthermore it also addresses the group of tumors known as combined hepatocellular-cholangiocellular carcinomas.
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MESH Headings
- Animals
- Bile Duct Neoplasms/chemistry
- Bile Duct Neoplasms/classification
- Bile Duct Neoplasms/epidemiology
- Bile Duct Neoplasms/pathology
- Bile Ducts, Intrahepatic/chemistry
- Bile Ducts, Intrahepatic/pathology
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Hepatocellular/chemistry
- Carcinoma, Hepatocellular/classification
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/pathology
- Cholangiocarcinoma/chemistry
- Cholangiocarcinoma/classification
- Cholangiocarcinoma/epidemiology
- Cholangiocarcinoma/pathology
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Liver Neoplasms/chemistry
- Liver Neoplasms/classification
- Liver Neoplasms/epidemiology
- Liver Neoplasms/pathology
- Neoplasm Grading
- Neoplasms, Complex and Mixed/chemistry
- Neoplasms, Complex and Mixed/classification
- Neoplasms, Complex and Mixed/epidemiology
- Neoplasms, Complex and Mixed/pathology
- Precancerous Conditions/chemistry
- Precancerous Conditions/classification
- Precancerous Conditions/epidemiology
- Precancerous Conditions/pathology
- Predictive Value of Tests
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16
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Saito T, Naito M, Matsumura Y, Kita H, Kanno T, Nakada Y, Hamano M, Chiba M, Maeda K, Michida T, Ito T. Spontaneous regression of a large hepatocellular carcinoma with multiple lung metastases. Gut Liver 2014; 8:569-74. [PMID: 25228980 PMCID: PMC4164250 DOI: 10.5009/gnl13358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/02/2013] [Accepted: 10/02/2013] [Indexed: 01/11/2023] Open
Abstract
A 75-year-old Japanese man with chronic hepatitis C was found to have a large liver tumor and multiple nodules in the bilateral lungs. We diagnosed the tumor as hepatocellular carcinoma (HCC) with multiple lung metastases based on imaging studies and high titers of HCC tumor markers. Remarkably, without any anticancer treatment or medication, including herbal preparations, the liver tumor decreased in size, and the tumor makers diminished. Moreover, after 1 year, the multiple nodules in the bilateral lungs had disappeared. Fifteen months after the first medical examination, transcatheter arterial chemoembolization (TACE) was performed for the residual HCC. Because local relapse was observed on follow-up computed tomography, a second TACE was performed 13 months after the first one. At 4 years after the second TACE (7 years after the initial medical examination), there was no recurrence of primary or metastatic lesions. Spontaneous regression of HCC is very rare, and its mechanism remains unclear. Understanding the underlying mechanism of this rare phenomenon may offer some hope of finding new therapies, even in advanced metastatic cases.
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Affiliation(s)
- Tamiko Saito
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Masafumi Naito
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Yuki Matsumura
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Hisaaki Kita
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Tomoyo Kanno
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Yuki Nakada
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Mina Hamano
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Miho Chiba
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Kosaku Maeda
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Tomoki Michida
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
| | - Toshifumi Ito
- Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan
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17
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Tomino T, Yamashita YI, Iguchi T, Itoh S, Ninomiya M, Ikegami T, Yoshizumi T, Soejima Y, Kawanaka H, Ikeda T, Aishima S, Shirabe K, Maehara Y. Spontaneous massive necrosis of hepatocellular carcinoma with narrowing and occlusion of the arteries and portal veins. Case Rep Gastroenterol 2014; 8:148-55. [PMID: 24926228 PMCID: PMC4036137 DOI: 10.1159/000362440] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We herein present the case of a 77-year-old man who had fever and right hypochondriac pain. He visited his doctor and underwent contrast computed tomography (CT), and he was suspected to have a liver abscess. He received an antibiotic treatment and his symptoms soon disappeared, but the tumor did not get smaller and its density on contrast CT image got stronger. He underwent biopsy and moderately differentiated hepatocellular carcinoma (HCC) was found. Extended left hepatic and caudate lobectomy was performed. Histological examination showed moderately differentiated HCC with narrowing and occlusion both in the arteries and portal veins associated with mild chronic inflammation. The mechanisms of spontaneous regression of HCC, such as immunological reactions and tumor hypoxia, have been proposed. In our case, histological examination showed the same findings. However, the mechanism is complex, and therefore further investigations are essential to elucidate it.
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Affiliation(s)
- Takahiro Tomino
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yo-Ichi Yamashita
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Iguchi
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuki Ninomiya
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuji Soejima
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Kawanaka
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuo Ikeda
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Aishima
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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18
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Lim DOH, Park KW, Lee SI. Spontaneous complete regression of multiple metastases of hepatocellular carcinoma: A case report. Oncol Lett 2014; 7:1225-1228. [PMID: 24944697 PMCID: PMC3961391 DOI: 10.3892/ol.2014.1869] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/15/2014] [Indexed: 01/30/2023] Open
Abstract
Spontaneous regression of cancer is a partial or complete disappearance of malignant tumor without specific treatment. Spontaneous regression of hepatocellular carcinoma (HCC) is a rare condition, and the mechanism underlying it is unclear. This report presents a rare case of spontaneous complete regression of HCC, as revealed by tumor markers and imaging studies. A 64-year-old Korean male patient with hepatitis B virus-associated chronic hepatitis presented with HCC. The patient had undergone right lobectomy of the liver but the cancer recurred with multiple lung and adrenal metastases after 14 months. The patient received palliative cytotoxic chemotherapy. However, there was no clinical benefit and the disease progressed. It was decided to discontinue anticancer therapy and administer only supportive care. After approximately six months, the symptoms disappeared and the HCC had completely regressed. The patient remains alive over five years after recurrence.
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Affiliation(s)
- DO Hyoung Lim
- Division of Hematology-Oncology, Department of Medicine, Dankook University College of Medicine, Cheonan 330-715, Republic of Korea
| | - Keon Woo Park
- Division of Hematology-Oncology, Department of Medicine, Dankook University College of Medicine, Cheonan 330-715, Republic of Korea
| | - Soon Il Lee
- Division of Hematology-Oncology, Department of Medicine, Dankook University College of Medicine, Cheonan 330-715, Republic of Korea
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19
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Yoo JJ, Lee JH, Lee KB, Koh JM, Lee M, Choi YH, Yoon JH. Pathologically Confirmed Spontaneous Partial Regression of Hepatocellular Carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.3904/kjm.2014.86.2.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Boon Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Moon Koh
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Minjong Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Choi
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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20
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Yokoyama T, Yoshida H, Hirakata A, Makino H, Maruyama H, Suzuki S, Matsutani T, Hayakawa T, Hosone M, Uchida E. Spontaneous complete necrosis of advanced hepatocellular carcinoma. J NIPPON MED SCH 2013; 79:213-7. [PMID: 22791123 DOI: 10.1272/jnms.79.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present a rare case of hepatocellular carcinoma (HCC) in which spontaneous complete necrosis was confirmed with surgical resection. An 80-year-old man with HCC was referred to Nippon Medical School Tama Nagayama Hospital. The medical history included hypertension, managed with medication, and partial lobectomy of the lung owing to a lung schwannoma. A previously untreated abdominal aortic aneurysm, 51 mm in maximum diameter, was detected. The serum concentration of proteins induced by vitamin k antagonism or absence (PIVKA-2) was 14,300 mAU/mL, and that of alpha-fetoprotein was 184.2 ng/mL. Antibodies against hepatitis B surface antigens and hepatitis C virus were not detected in the serum. Computed tomography (CT) demonstrated a hypervascular tumor, 68 mm in diameter, in the left paramedian sector of the liver with washout of contrast medium in the delayed phase. An HCC in the left paramedian sector was diagnosed. Laparotomy was performed 40 days after CT scanning. Intraoperative ultrasonography showed that the HCC had shrunk to 30 mm in diameter. A left paramedian sectionectomy was performed. On macroscopic examination the surgical specimen was a firm mass, 30 mm in diameter, with a fibrous capsule. Histologic examination showed that the tumor in the cirrhotic liver had been completely replaced by central coagulative necrosis, circumferential fibrosis, and dense infiltrates of inflammatory cells. No viable HCC cells were observed in the coagulative necrosis. Organized thrombi in the hepatic artery were detected in the tumor. The tumor also contained multiple foci of old hemorrhage, ductular proliferation, and granulation tissue. The patient was discharged 10 days after the operation. After 1 month, the serum concentrations of PIVKA-2 (25 mAU/mL) and alpha-fetoprotein (5.9 ng/mL) had decreased to within their normal ranges.
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Affiliation(s)
- Tadashi Yokoyama
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan
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21
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Shinoda M, Kadota Y, Tsujikawa H, Masugi Y, Itano O, Ueno A, Mihara K, Hibi T, Abe Y, Yagi H, Kitago M, Kawachi S, Tanimoto A, Sakamoto M, Tanabe M, Kitagawa Y. Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature. World J Surg Oncol 2013; 11:97. [PMID: 23642182 PMCID: PMC3654885 DOI: 10.1186/1477-7819-11-97] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 04/08/2013] [Indexed: 12/15/2022] Open
Abstract
We report a rare case of lymphoepithelioma-like hepatocellular carcinoma. A 79-year-old Japanese man had undergone curative resection of extrahepatic bile ducts because of bile duct cancer 9 years prior. The bile duct cancer was diagnosed as mucosal adenocarcinoma, and the patient had been followed up every 6 months for the last 9 years. A recent computed tomography examination revealed a tumor, 4.2 cm in size, in the lateral segment of the liver. Based on the imaging findings, the tumor was diagnosed as hepatocellular carcinoma. Serology tests were negative for hepatitis B and C viruses. Chest and abdominal image analyses showed no evidence of metastasis, but a swollen lymph node was noted around the abdominal aorta. The patient subsequently underwent extended lateral segmentectomy and resection of the swollen lymph node. Microscopically, the tumor had the characteristic appearance of poorly differentiated hepatocellular carcinoma. Moreover, an abundant infiltration of inflammatory cells was observed in the tumor. Therefore, we diagnosed the tumor as lymphoepithelioma-like hepatocellular carcinoma. The resected para-aortic lymph node also had a carcinoma with features similar to those of the main tumor. The patient has been alive for 20 months since performance of the surgery. Since the first report of lymphoepithelioma-like hepatocellular carcinoma in 2000, only nine cases have been reported in the medical literature, and the clinicopathological features of the disease have not been well documented. Herein, we describe the clinicopathological features of this case for further understanding of the disease and review past cases in the literature.
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Affiliation(s)
- Masahiro Shinoda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
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22
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Sasaki T, Fukumori D, Yamamoto K, Yamamoto F, Igimi H, Yamashita Y. Management considerations for purported spontaneous regression of hepatocellular carcinoma: a case report. Case Rep Gastroenterol 2013; 7:147-52. [PMID: 23626515 PMCID: PMC3617977 DOI: 10.1159/000350501] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Spontaneous regression of hepatocellular carcinoma (HCC) is an extraordinary phenomenon that occurs rarely. While more than 80 cases have been described, most have been established via radiological findings or examination of biopsy tissues rather than via pathological examination of a resected specimen. The present report describes a purported case of spontaneous regression of HCC as indicated by radiological examination. Subsequent immunostaining of surgically resected specimens revealed viable cancer cells, though only necrotic tissues were seen on hematoxylin and eosin staining. These data indicate that viable cancer cells may still be present even if imaging findings suggest spontaneous regression of HCC. Therefore, these patients should receive aggressive treatment similar to that used for patients with established HCC.
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Affiliation(s)
- Takahide Sasaki
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Imari, Japan ; Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
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23
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Huang TM, Luo GR. Mechanisms underlying spontaneous regression of hepatocellular carcinoma. Shijie Huaren Xiaohua Zazhi 2012; 20:1939-1948. [DOI: 10.11569/wcjd.v20.i21.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We searched MEDLINE and identified 85 cases of spontaneous regression of hepatocellular carcinoma (HCC). Analysis of these cases found that immunity is the most likely cause of spontaneous regression of HCC, and the elimination of immunosuppressive microenvironment may play a key role in this process. Ischemia, ethanol abstinence, and blood transfusion might lead to regression of HCC through the elimination of immunosuppression and activation of antitumor immunity.
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24
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Yamamoto S, Tokuhara T, Nishikawa M, Nishizawa S, Nishioka T, Nozawa A, Takahashi A, Watanabe Y, Wada R, Wakasa K, Kubo S. Spontaneous regression of hepatocellular carcinoma after improving diabetes mellitus: possibly responsible for immune system. ACTA ACUST UNITED AC 2012. [DOI: 10.2957/kanzo.53.164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Storey RE, Huerta AL, Khan A, Laber DA. Spontaneous complete regression of hepatocellular carcinoma. Med Oncol 2010; 28:948-50. [PMID: 20467917 DOI: 10.1007/s12032-010-9562-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
In medical terminology, spontaneous regression of cancer refers to exceptional and unexplained partial or complete disappearance of cancer without medical intervention. This phenomenon has been described in various malignancies with no well established causative factors, except perhaps immune mediated. Here we present a rare case of hepatocellular carcinoma with possible metastasis to the lung by computed tomography with complete regression of both the primary tumor and the pulmonary nodules without medical intervention. Our patient may represent the first case of complete regression of the HCC with possible lung metastasis by computed tomography caused by abstinence from alcohol. This phenomenon was confirmed by surgical resection and pathologic evaluation.
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Affiliation(s)
- Raul E Storey
- Department of Medicine, Division of Hematology-Oncology, James G. Brown Cancer Center, University of Louisville, 529 S. Jackson Street, Louisville, KY 40202, USA.
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