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Curry L, Limaye W, Ramjeesingh R. Spontaneous regression of metastatic hepatocellular carcinoma following 3 weeks of lenvatinib. BMJ Case Rep 2022; 15:e247212. [PMID: 35140091 PMCID: PMC8830208 DOI: 10.1136/bcr-2021-247212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/03/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality and is associated with a poor prognosis. Rarely, there is spontaneous regression of the tumour. We present a case of a middle-aged male with presumed metastatic HCC who experienced enduring regression following 3 weeks of lenvatinib, which was discontinued due to side effects. While this could represent an unusually successful response to therapy, spontaneous tumour regression or an alternative diagnosis should be considered. We discuss possible mechanisms that might explain this unusual case and advocate for tissue confirmation in select cases, where there is diagnostic doubt or when the disease pattern does not clearly follow the recognised natural history. Therefore, if regression occurs-whether spontaneous or in response to treatment-it can be better understood and subsequent therapies recommended.
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Affiliation(s)
- Lauren Curry
- Department of Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Warda Limaye
- Department of Diagnostic Radiology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ravi Ramjeesingh
- Department of Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Division of Medical Oncology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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2
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Stefanczyk-Sapieha L, Fainsinger RL. Hepatocellular Carcinoma: Misdiagnosis or Spontaneous Remission? J Palliat Care 2019. [DOI: 10.1177/082585970802400108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Robin L. Fainsinger
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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3
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Okano A, Ohana M, Kusumi F, Nabeshima M. Spontaneous Regression of Hepatocellular Carcinoma due to Disruption of the Feeding Artery. Case Rep Oncol 2013; 6:180-5. [PMID: 23626558 PMCID: PMC3636963 DOI: 10.1159/000350682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present an unusual case of spontaneous regression of hepatocellular carcinoma (HCC). A 77-year-old man with alcoholic liver cirrhosis presented with a 50-mm tumor in the Couinaud's segment 8 (S8) of the liver, a 15-mm tumor in the S8-7 and 10-mm tumors in the other segments (S4, S6). The tumors were diagnosed as HCC by typical imaging findings and elevated serum alpha-fetoprotein (AFP, 1,825.0 ng/ml) and protein induced by vitamin K absence II (PIVKA II, 3,043 mAU/ml). One month later, AFP and PIVKA II decreased to 51.1 ng/ml and 411 mAU/ml, respectively, and the 50-mm tumor in the S8 became small and completely necrotic on angiography and computed tomography arteriography without any treatment. On the other hand, the 15-mm tumor in the S8-7 decreased in size to 10 mm and received blood supply from the right posterior superior arteries (A7). The other 10-mm tumors remained. Ischemia of the tumors due to disruption of the feeding artery (A8) might have induced tumor regression in the present case.
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Affiliation(s)
- Akihiro Okano
- Department of Gastroenterology, Tenri Hospital, Tenri, Japan
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4
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Huz JI, Melis M, Sarpel U. Spontaneous regression of hepatocellular carcinoma is most often associated with tumour hypoxia or a systemic inflammatory response. HPB (Oxford) 2012; 14:500-5. [PMID: 22762397 PMCID: PMC3406346 DOI: 10.1111/j.1477-2574.2012.00478.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Spontaneous regression of hepatocellular carcinoma (HCC) is well documented, although the aetiology of this phenomenon remains unknown. METHODS A review of the English literature was performed for reports of spontaneous regression of HCC. Reports were classified by mechanism based on the available information. RESULTS Spontaneous regression of HCC has been identified in 75 patients. The most common mechanisms of regression identified were tumour hypoxia (n= 21, 28.0%), a systemic inflammatory response (n= 25, 33.3%) and unknown (n= 29, 38.7%). In patients where tumour hypoxia was described as the aetiology, mechanisms included spontaneous hepatic artery thrombosis and sustained systemic hypotension. In patients where a systemic inflammatory response was the aetiology, mechanisms included cholangitis, trauma and elevated cytokine levels. DISCUSSION Spontaneous regression of HCC is most commonly associated with tumour hypoxia or a systemic inflammatory response. Determining the aetiology of spontaneous regression may identify potential therapeutic pathways. Tumour hypoxia is already the basis of treatment modalities such as hepatic artery embolization and the anti-angiogenic agent sorafenib. However, treatment modalities for HCC do not currently include immune-directed therapies; this may prove to be a worthy target for future research.
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Affiliation(s)
- Jonathan I Huz
- Department of Surgery, New York University School of Medicine, NY 10029, USA
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5
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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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6
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Oquiñena S, Iñarrairaegui M, Vila JJ, Alegre F, Zozaya JM, Sangro B. Spontaneous regression of hepatocellular carcinoma: three case reports and a categorized review of the literature. Dig Dis Sci 2009; 54:1147-53. [PMID: 18716866 DOI: 10.1007/s10620-008-0447-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 07/02/2008] [Indexed: 12/21/2022]
Affiliation(s)
- Susana Oquiñena
- Department of Gastroenterology, Hospital Virgen del Camino, Pamplona, Spain
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7
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Spontaneous regression of hepatocellular carcinoma is possible and might have implications for future therapies. Eur J Gastroenterol Hepatol 2008; 20:804-9. [PMID: 18617788 DOI: 10.1097/meg.0b013e3282f2bbcc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hepatocellular carcinoma is a potentially challenging cancer with very high mortality. Medical therapies are generally ineffective in achieving complete remission, especially for aggressive types or for advanced stage cancers. Spontaneous regression of these tumors is a rare and fascinating phenomenon. We describe such a patient with spontaneous regression of a large multi-focal hepatocellular carcinoma, and present a comprehensive review of the reported cases with a special emphasis on potential regression mechanisms.
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Kondo S, Okusaka T, Ueno H, Ikeda M, Morizane C. Spontaneous regression of hepatocellular carcinoma. Int J Clin Oncol 2007; 11:407-11. [PMID: 17058140 DOI: 10.1007/s10147-006-0591-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 05/22/2006] [Indexed: 02/07/2023]
Abstract
We report four patients with hepatocellular carcinoma (all men, with liver cirrhosis and hepatitis C virus infections) who showed spontaneous regression of the tumor. When the spontaneous regression occurred all of the patients were over age 67 years. They showed a rapid increase of serum alpha-fetoprotein levels just before the spontaneous regression of hepatocellular carcinoma. In all the patients, the alpha-fetoprotein level decreased to within normal limits and the tumor was partially to completely reduced in size. One patient revealed regression after bleeding of esophageal varices and blood transfusion. Another showed spontaneous regression after taking several complementary and alternative medicines. However, the mechanisms underlying this intriguing phenomenon remain unknown.
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Affiliation(s)
- Shunsuke Kondo
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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9
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Wersäll PJ, Blomgren H, Pisa P, Lax I, Kälkner KM, Svedman C. Regression of non-irradiated metastases after extracranial stereotactic radiotherapy in metastatic renal cell carcinoma. Acta Oncol 2006; 45:493-7. [PMID: 16760190 DOI: 10.1080/02841860600604611] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Ohtani H, Yamazaki O, Matsuyama M, Horii K, Shimizu S, Oka H, Nebiki H, Kioka K, Kurai O, Kawasaki Y, Manabe T, Murata K, Matsuo R, Inoue T. Spontaneous regression of hepatocellular carcinoma: report of a case. Surg Today 2006; 35:1081-6. [PMID: 16341493 DOI: 10.1007/s00595-005-3066-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 03/15/2005] [Indexed: 12/26/2022]
Abstract
A spontaneous regression of hepatocellular carcinoma is an extremely rare phenomenon. A 69-year-old Japanese man with hepatitis C virus-related chronic hepatitis presented with a liver tumor. We diagnosed the tumor to be hepatocellular carcinoma in the course of spontaneous regression, by imaging studies and changes in the tumor markers. Because the possible presence of viable cancer cells could not be ruled out, we recommended surgery. He refused all treatments at first, but finally agreed to undergo surgery about 10 months after presentation. A hepatectomy was performed. Histologically, no viable tumor cells were found. In our case, the vascularity of the tumor according to the imaging findings was followed up during the clinical course. The patient is now doing well and without any evidence of recurrence at 37 months after surgery.
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Affiliation(s)
- Hiroshi Ohtani
- Department of Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Japan
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11
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Yano Y, Yamashita F, Kuwaki K, Fukumori K, Kato O, Kiyomatsu K, Sakai T, Yamamoto H, Yamasaki F, Ando E, Sata M. Partial spontaneous regression of hepatocellular carcinoma: a case with high concentrations of serum lens culinaris agglutinin-reactive alpha fetoprotein. Kurume Med J 2006; 52:97-103. [PMID: 16422176 DOI: 10.2739/kurumemedj.52.97] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Spontaneous regression of hepatocellular carcinoma (HCC) is rare. There are few reports discussing spontaneous regression associated with serum lens culinaris agglutinin-reactive alpha fetoprotein (AFP-L3). We describe a case of HCC with a high level of AFP-L3, which showed a rapid increase in alpha fetoprotein (AFP) concentration after partial spontaneous regression, and which was then treated successfully. A 71-year-old woman suffering from chronic hepatitis C underwent surgical resection for HCC. Preoperative concentrations of AFP fluctuated; subsequent to a transient decrease, a rapid increase in AFP was observed. AFP-L3 concentration was extremely high. The resected tissue consisted of encapsulated moderately differentiated HCC, subcapsular coagulation necrosis, and chronic active hepatitis. The postoperative course was uneventful. At present, 24 months after diagnosis, no symptoms or signs of tumor recurrence or metastasis have been observed. Although the precise etiology of the spontaneous regression in this patient is not known, we speculate that spontaneous regression of tumor cells with high malignant potential may be related to arterial involvement and insufficient blood supply.
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Affiliation(s)
- Yoichi Yano
- Department of Medicine, Saga Social Insurance Hospital, Saga 849-8522, Japan.
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12
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Cheng HM, Tsai MC. Regression of hepatocellular carcinoma spontaneous or herbal medicine related? THE AMERICAN JOURNAL OF CHINESE MEDICINE 2005; 32:579-85. [PMID: 15481647 DOI: 10.1142/s0192415x04002211] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hepatocellular carcinoma is one of the most common causes of death from cancer in Taiwan. Treatments for this disease include surgical resection, transcatheter arterial embolization, chemoembolization and systemic chemotherapy. Without treatment, the prognosis of hepatocellular carcinoma is poor, and mortality continues to be significant even in patients with small tumors detected during follow-up. For patients in Taiwan with advanced hepatocellular carcinoma, traditional herbal medicine is frequently used. However, neither the overall prevalence of this therapy nor its efficacy has been studied systematically. Spontaneous regression of cancer, although rare, may occur, but the mechanism leading to regression is still far from understood. Here, we report a case of hepatocellular carcinoma with complete regression after taking herbal medicine. We cannot be certain how significant the herbal preparation was in the regression of the hepatocellular carcinoma, but the regression of the tumor provides us a reason and hope for further research.
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Affiliation(s)
- Hon Mei Cheng
- Department of Internal Medicine, Chi Mei Medical Center Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
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Nam SW, Han JY, Kim JI, Park SH, Cho SH, Han NI, Yang JM, Kim JK, Choi SW, Lee YS, Chung KW, Sun HS. Spontaneous regression of a large hepatocellular carcinoma with skull metastasis. J Gastroenterol Hepatol 2005; 20:488-92. [PMID: 15740500 DOI: 10.1111/j.1440-1746.2005.03243.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Spontaneous regression of hepatocellular carcinoma (HCC) is a rare phenomenon. This case of a 65-year-old Korean man with HCC and metastatic frontal bone mass that regressed after radiotherapy for frontal bone mass without any other therapeutic modalities is described. The clinical diagnosis of HCC was made because of the presence of a liver mass on abdominal computed tomography (CT) scan, high serum alpha-fetoprotein value and tissue diagnosis on frontal bone biopsy. The patient refused any other recommended treatments, but accepted the radiation therapy due to a painful frontal bone mass, and ingested mushroom called Phellinus linteus for one and a half years. Ten months after radiation therapy, he experienced a reduction in size of the frontal bone mass and improvement of lesions in the liver, sternum and ribs. The patient is alive and in good condition without any symptoms or tumor aggravation in August 2002. It was concluded that a rare case of spontaneous regression of HCC had occurred.
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Affiliation(s)
- Soon Woo Nam
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Armengol C, Tarafa G, Boix L, Solé M, Queralt R, Costa D, Bachs O, Bruix J, Capellá G. Orthotopic implantation of human hepatocellular carcinoma in mice: analysis of tumor progression and establishment of the BCLC-9 cell line. Clin Cancer Res 2004; 10:2150-7. [PMID: 15041736 DOI: 10.1158/1078-0432.ccr-03-1028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To allow the longitudinal investigation of molecular events associated with the progression of human hepatocellular carcinoma (HCC), we sought to develop a murine model by orthotopic implantation of tumor fragments obtained from patients diagnosed at early stage. EXPERIMENTAL DESIGN Tumor pieces (2 x 2 mm) were implanted on the liver surface of nu/nu mice. After xenograft growing, subsequent passages were performed to achieve long-term implant viability. Isolation of tumoral hepatocytes was done to establish new cell lines. HCC characteristics, proliferation rate, apoptotic index (terminal deoxynucleotidyl transferase-mediated nick end labeling), and expression of cell-cycle regulators (cyclins E and A, p21(Cip1), p27(Kip1), p16(INK4a), pRb, and p53) were assessed by Western Blot and immunohistochemistry, to correlate them with tumor progression. RESULTS Five (50%) of the 10 primary HCCs resulted in small slow-growing liver implants. Three of them are viable after 48 months, whereas the remaining two survived for 15 and 13 months. Xenografts throughout passages exhibited a more aggressive phenotype with a poorer degree of differentiation, intense proliferation, moderate apoptosis, cell-cycle deregulation, p53 alterations, microvascular invasion, and dissemination. In one single passage, we observed critical growth delay, which was associated with significant p27(kip1) overexpression. We established the anchor-free growing BCLC-9 cell line from one xenograft. This has gains of chromosomes 7, 5p, 6q, and 9q, is hepatitis B virus-DNA positive, does not secrete alpha-fetoprotein, and has TP53 missense mutations in codons 192 and 242. CONCLUSIONS The orthotopic implantation of early HCC fragments in nude mice provides a useful model to investigate the mechanisms of human HCC evolution and to establish new cell lines.
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Affiliation(s)
- Carolina Armengol
- BCLC Group, Liver Unit, Digestive Disease Institute, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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15
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Blondon H, Fritsch L, Cherqui D. Two cases of spontaneous regression of multicentric hepatocellular carcinoma after intraperitoneal rupture: possible role of immune mechanisms. Eur J Gastroenterol Hepatol 2004; 16:1355-9. [PMID: 15618845 DOI: 10.1097/00042737-200412000-00020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We report two cases of spontaneous regression of hepatocellular carcinoma. Firstly, a 64-year-old man with alcohol related cirrhosis developed multiple liver tumours with elevation of the alpha-fetoprotein level at 915 ng/ml. A spontaneous regression of all the tumoural masses but one and normalization of the alpha-fetoprotein level was observed after intraperitoneal spread of the malignancy. Resection of the remaining tumour 9 months later confirmed a hepatocellular carcinoma. Secondly, a 70-year-old woman with alcohol related cirrhosis developed multiple liver tumours with elevation of the alpha-fetoprotein level to 4000 ng/ml; a regression of all the tumoural masses but one and a decrease of the alpha-fetoprotein level to 400 ng/ml was observed after intraperitoneal spread of the malignancy and treatment with tamoxifen. We discuss a possible immune mechanism of tumoural regression with a review of similar cases described in the literature.
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MESH Headings
- Aged
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/pathology
- Female
- Humans
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Male
- Middle Aged
- Neoplasm Regression, Spontaneous/immunology
- Neoplasm Regression, Spontaneous/pathology
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/immunology
- Neoplasms, Multiple Primary/pathology
- Peritoneal Diseases/diagnostic imaging
- Peritoneal Diseases/pathology
- Rupture, Spontaneous/diagnostic imaging
- Rupture, Spontaneous/pathology
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Hugues Blondon
- Department of Hepato-gastroenterology, Centre Hospitalier, Montargis, France.
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Feo CF, Marrosu A, Scanu AM, Ginesu GC, Fancellu A, Migaleddu V, Porcu A. Spontaneous regression of hepatocellular carcinoma: report of a case. Eur J Gastroenterol Hepatol 2004; 16:933-6. [PMID: 15316421 DOI: 10.1097/00042737-200409000-00020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The widespread use of ultrasound in screening programmes for chronic liver disease has led to early diagnosis of hepatocellular carcinoma (HCC), and to the observation of some cases of tumour spontaneous regression. This is a rare event whose underlying mechanism is still unclear. We present here a case of spontaneous regression of HCC in a 71-year-old woman with chronic hepatitis and discuss possible aetiologies. None of the causative mechanisms proposed for spontaneous regression of HCC is completely satisfactory, so further studies are necessary to improve understanding of this unusual biological event. Therefore, we stress the importance of accumulating all such cases in the literature, because the clarification of aetio-pathogenic mechanisms may lead to the development of new treatment strategies for HCC.
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Affiliation(s)
- Claudio F Feo
- Department of Surgery, Institute of Clinica Chirurgica, Italy.
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18
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Garrido Serrano A, Guerrero Igea FJ, Lepe Jiménez JA, Palomo Gil S. [Spontaneous regression of hepatocellular carcinoma in a cirrhotic patient]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:503-5. [PMID: 11730620 DOI: 10.1016/s0210-5705(01)70223-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hepatocellular carcinoma mainly affects patients with liver disease and rarely develops in healthy liver. Cirrhosis greatly increases the risk of developing this malignancy and consequently these patients are candidates for close follow-up and surveillance. The most commonly used screening programs are abdominal ultrasonography and serum alpha-fetoprotein determination. Without treatment, the prognosis of hepatocellular carcinoma is poor and mortality continues to be significant even in patients with small tumors detected during follow-up. We present the case of a 71-year-old male patient with alcoholic cirrhosis. The patient was diagnosed during follow-up of a single hepatocellular carcinoma of 4 cm in diameter. Although he refused all treatment, evolution was favorable, serum alpha-fetoprotein levels returned to normal and ultrasonographic images compatible with hepatocellular carcinoma disappeared. Three years after diagnosis, the patient was completely asymptomatic.
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19
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Quaglia A, Bhattacharjya S, Dhillon AP. Limitations of the histopathological diagnosis and prognostic assessment of hepatocellular carcinoma. Histopathology 2001; 38:167-74. [PMID: 11207830 DOI: 10.1046/j.1365-2559.2001.01000.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Quaglia
- Department of Histopathology, Royal Free and University College Medical School, Royal Free Campus, London, UK
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20
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Takeda Y, Togashi H, Shinzawa H, Miyano S, Ishii R, Karasawa T, Takeda Y, Saito T, Saito K, Haga H, Matsuo T, Aoki M, Mitsuhashi H, Watanabe H, Takahashi T. Spontaneous regression of hepatocellular carcinoma and review of literature. J Gastroenterol Hepatol 2000; 15:1079-86. [PMID: 11059943 DOI: 10.1046/j.1440-1746.2000.02202.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 68-year-old man presented with multiple hepatocellular carcinoma, which was considered to be unresectable at the first admission in January 1994. Pathological diagnosis was made by biopsy of the one lesion among them. From January 1994 to December 1997, 10 transarterial chemoembolizations and six percutaneous ethanol injection therapies were performed on the tumours in the cirrhotic liver. In February 1998 the tumour situated in the right lobe began to increase in size. The maximum tumour diameter was 6.3 cm measured by computed tomography (CT). In the beginning of May 1998 moderate ascites was present and mild hepatic encephalopathy was noticed. The patient was in the terminal stage of hepatocellular carcinoma and no further treatment was possible at that time. However, serum alpha-fetoprotein and protein induced by vitamin K absence or antagonist II dramatically decreased in June 1998. The CT scan also showed that the tumour had completely regressed without specific treatment. In February 1999 a new biopsy-proven hepatocellular carcinoma, 2 cm in diameter, developed in the lateral segment of the liver. It was well treated by percutaneous ethanol injection therapy. The patient was alive in good condition without any symptoms or tumour recurrence in June 1999. It was concluded that a rare case of spontaneous regression of hepatocellular carcinoma had occurred.
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Affiliation(s)
- Y Takeda
- Second Department of Internal Medicine, Yamagata University School of Medicine, Japan
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Abstract
Spontaneous regression of cancer is a rare phenomenon seldom described in patients with hepatocellular carcinoma. A 54-year-old Korean woman suffered from cytologically-proved advanced hepatocellular carcinoma, for which she received no treatment. Papanicolaou's smears revealed high cellularity. Many clusters of polygonal cells showed long, thick anastomosing cords covered by flattened endothelial cells. The polygonal cells showed small hepatocytoid appearance, characterized by increased nuclear/cytoplasmic ratio. She remained in good clinical condition and, at 4 years of follow-up, the hepatocellular carcinoma could not be visualized radiologically. To date, only 14 case reports of apparently spontaneous regression of hepatocellular carcinoma have been published in the English literature. The mechanisms underlying this intriguing phenomenon remain unknown.
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Affiliation(s)
- T J Jang
- Department of Pathology and Radiology, Dongguk University, College of Medicine, Kyongju, Kyongbuk, Korea
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Ng FH, Chow KC, Cheng CS, Kng C, Ng WF, Wong BC. High alpha-fetoprotein level in HCV-related nodular liver cell dysplasia. Am J Gastroenterol 1999; 94:2296-7. [PMID: 10445567 DOI: 10.1111/j.1572-0241.1999.01319.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of hepatocellular carcinoma is generally made in patients with a mass lesion in the cirrhotic liver if the alpha-fetoprotein level is >1,000 ng/L. Other causes of elevation of alpha-fetoprotein to this extreme degree include nonseminomatous germ cell tumor and hepatic metastasis. However, it is extremely rare for benign hepatic lesions to cause alpha-fetoprotein of > 1,000 ng/ml. We report a Chinese patient with spontaneous normalization of alpha-fetoprotein with an initial value > 10,000 ng/ml due to nodular dysplasia complicating hepatitis C-related liver cirrhosis. The alpha-fetoprotein was secreted from the dysplastic liver cells.
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Affiliation(s)
- F H Ng
- Department of Medicine, Ruttonjee Hospital, Wan Chai, Hong Kong, China
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