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Kakuta N, Yasumoto T, Yoshida Y, Tsuda M, Miyazaki A, Miyamoto S, Inada R, Yorifuji H, Higami Y, Tetsumoto S, Miyazaki M, Katada Y, Naito M. Spontaneous regression of lung metastases after transarterial chemoembolization for hepatocellular carcinoma. Radiol Case Rep 2021; 16:1530-1534. [PMID: 33948129 PMCID: PMC8081867 DOI: 10.1016/j.radcr.2021.03.027] [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: 02/10/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023] Open
Abstract
Spontaneous regressions of primary and/or metastatic lesions have been rarely reported in hepatocellular carcinoma (HCC). Herein, we report the case of a 71-year-old man with HCC, focusing on shape changes of lung metastases over time. Lung metastasis of HCC was histologically diagnosed by percutaneous computed tomography (CT)-guided needle biopsy after the treatment of primary HCC lesion. Lung lesions had been observed on enhanced contrast computed tomography for >3 years without any local or systemic treatment for them. During this period, treatments including surgical procedure for relapsed bladder cancer and transarterial chemoembolization for HCC were performed. Metastatic lung lesions immediately regressed after these treatments. Therefore, accumulation of such cases may help elucidate spontaneous regression mechanisms in primary HCC or its lung metastases.
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Affiliation(s)
- Naoko Kakuta
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Taku Yasumoto
- Department of Interventional Radiology, Miyakojima IGRT Clinic, 1-16-22, Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Yuichi Yoshida
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Manabu Tsuda
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Akito Miyazaki
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Satoshi Miyamoto
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Reiko Inada
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Hideki Yorifuji
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Yuichi Higami
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Satoshi Tetsumoto
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Masaki Miyazaki
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Yoshinori Katada
- Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Masafumi Naito
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita City, Osaka, Japan
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Mehta S, Schwarz L, Spiliotis J, Hsieh MC, Akaishi EH, Goere D, Sugarbaker PH, Baratti D, Quenet F, Bartlett DL, Villeneuve L, Kepenekian V. Is there an oncological interest in the combination of CRS/HIPEC for peritoneal carcinomatosis of HCC? Results of a multicenter international study. Eur J Surg Oncol 2018; 44:1786-1792. [PMID: 29885982 DOI: 10.1016/j.ejso.2018.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/22/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Peritoneal metastasis (PM) of hepatocellular carcinoma (HCC) without distant spread are rare. The related prognosis is poor without standard treatment available. The role of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is poorly documented. METHODS An international multicentric cohort was constituted by retrospective analysis of 21 patients undergoing CRS/HIPEC for PM of HCC between 1992 and 2016 from 10 reference centers of PSOGI. Data on clinical features, treatment strategies, and survival outcomes were analyzed. RESULTS The median time interval from the diagnosis of PM to the procedure was 4.5 months. The median peritoneal cancer index was 14. Sixteen patients had complete cytoreduction (CCR0-1). Ten patients had grades 3 to 4 complications. The median duration of follow-up was 52.2 months. The median OS was 46.7 months. The projected 3y-OS and 5y-OS were 88.9 and 49.4% respectively. The median OS for patients with CCR0-1 resection was not reached whereas it was 5.9 months for those with CCR2-3 resection after CRS (p = 0.0005). The median RFS was 26.3 months and projected RFS at 3 years of 36.5 months Three prognostic factors were associated with improved RFS in the univariate analysis: preoperative chemotherapy (p = 0.0156), PCI >15 (p = 0.009), Number of chemotherapy agents used for HIPEC (p = 0.005). CONCLUSION CRS/HIPEC is a safe and effective approach in selected patients with PM of HCC. CRS/HIPEC gives the patient a chance for a good relapse free and overall survival and should be considered as an option.
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Affiliation(s)
- Sanket Mehta
- Department of Peritoneal Surface Oncology, Saifee Hospital, Mumbai, India
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France.
| | - John Spiliotis
- First Department of Surgical Oncology, Metaxa Cancer Memorial Hospital, Piraeus, Greece
| | - Mao-Chih Hsieh
- Department of General Surgery, Wan-Fang Hospital, Tapei, Taiwan
| | - Eduardo H Akaishi
- Department of Surgical Oncology, Centro de Oncologia Hospital Sirio Libanes, Sao Paulo, Brazil
| | - Diane Goere
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Paul H Sugarbaker
- Department of Surgical Oncology, Washington Hospital Center, Washington, United States
| | - Dario Baratti
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - François Quenet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - David L Bartlett
- Department of Surgery, University of Pittsburgh Medical Center Shaydyside Hospital, Pittsburgh, United States
| | - Laurent Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- EMR 3738, Lyon 1 University, Lyon, France; Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Yoo YJ, Kim JH. [Spontaneous Complete Remission of Hepatocellular Carcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 66:359-62. [PMID: 27175457 DOI: 10.4166/kjg.2015.66.6.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Clinicopathological factors and long-term outcome comparing between lung and peritoneal metastasectomy after hepatectomy for hepatocellular carcinoma in a tertiary institution. Surgery 2014; 157:645-53. [PMID: 25794626 DOI: 10.1016/j.surg.2014.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/20/2014] [Accepted: 07/22/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recurrence after liver resection for hepatocellular carcinoma (HCC) is common. Resection of extrahepatic recurrences such as lung metastasectomy (LM) has been well documented. Conversely, reports on the long-term outcomes of peritoneal metastasectomy (PM) are lacking. In this study, we compared the outcome of lung and peritoneal metastasectomy after hepatectomies for HCC in a tertiary institution. METHODS We reviewed retrospectively the data of 1,222 patients who underwent hepatectomies for HCC in Samsung Medical Center in Korea from January 2006 to August 2010. We studied the clinicopathologic factors between resected lung metastasis (LM) and peritoneal metastases (PM) and the long-term outcome of patient survival. Kaplan-Meier analysis was used to study the survival outcome. RESULTS The recurrence rate of resected HCC in this cohort was 41.6% (n = 508). Thirty-two patients with lung metastasis (23% of all lung metastasis) underwent LM whereas 13 patients (36% of all peritoneal metastasis) with peritoneal metastasis underwent PM. Two patients underwent PM and LM sequentially. Demographic and clinical data between the LM and PM groups were comparable. The mean prehepatectomy PIVKA-II level was greater in the LM group compared with the PM group (P = .029). On univariate analysis of pathologic factors, the median tumor size (P = .005), proportion of patients with tumor >75 mm (P = .005) and rate of microvascular invasion (P = .047) were greater in the LM group. The median time-to-recurrence in the LM group was 12 (4-45) months compared with 18 (1-102) months in the PM group (P = .896). The 1-year, 3-year, and 5-year overall survival of patients in the LM group was 92%, 55%, 55% (4-year) whereas that in the PM group was 90%, 75%, and 75%, respectively. The mean overall survival in the LM was comparable with that in the PM group (P = .578). CONCLUSION Twenty-three percent of patients with lung metastasis and 36.1% of patients with peritoneal metastasis could be considered for metastasectomy. The long-term survival of patients with PM and LM was comparable in this study. Although resection of LM improves survival in patients with resected HCC, we demonstrated favorable outcomes for PM as well, which in the past would have been considered palliative.
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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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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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Kow AWC, Kwon CHD, Song S, Shin M, Kim JM, Joh JW. Risk factors of peritoneal recurrence and outcome of resected peritoneal recurrence after liver resection in hepatocellular carcinoma: review of 1222 cases of hepatectomy in a tertiary institution. Ann Surg Oncol 2012; 19:2246-55. [PMID: 22402812 PMCID: PMC3381119 DOI: 10.1245/s10434-012-2260-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking. We examined the risk factors of PR after hepatectomy and the outcome of resected PR at our institution. METHODS We retrospectively reviewed the data from 1,222 patients who underwent hepatectomies for hepatocellular carcinoma in Samsung Medical Center from January 2006 to August 2010. We identified patients with PR and studied the risk factors and outcomes of resected PR. RESULTS The rate of PR was 3.0% (n=36). The mean±SD age of patients was 54.0±10.2 years. Among those with PR, 23 patients (63.9%) had unresectable disease and 13 patients (36.1%) had resectable disease. Multivariate analysis found that tumor size>50 mm, presence of microvascular invasion, bile duct invasion, and positive margins were significant risk factors of PR after liver resection. The median overall survival (OS) for resectable PR was 33.0 (28.0-61.6) months compared to 14.0 (6.8-21.2) months for unresectable PR (P=0.009). Cox regression analysis demonstrated that resected PR [hazard ratio (HR) 0.042, P = 0.001] and interval between hepatectomy and PR (>6 months) (HR 0.195, P=0.016) were positive prognostic factors for OS, while alfa-fetoprotein>200 ng/dl at detection of PR (HR 11.321, P=0.015) and serosal involvement of primary hepatocellular carcinoma (HR 25.616, P=0.007) were negative prognostic factors for OS. CONCLUSIONS We found that tumor size>50 mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection. Selected patients with resected PR had significantly better OS.
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Affiliation(s)
- Alfred Wei Chieh Kow
- Department of HPB Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sanghyun Song
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Milljae Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Alqutub A, Peck D, Marotta P. Spontaneous regression of a large hepatocellular carcinoma: case report. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2011; 9:Doc07. [PMID: 21468325 PMCID: PMC3070436 DOI: 10.3205/000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 03/13/2010] [Indexed: 11/30/2022]
Abstract
The prognosis of untreated advanced hepatocellular carcinoma (HCC) is grim with a median survival of less than 6 months. Spontaneous regression of HCC has been defined as the disappearance of the hepatic lesions in the absence of any specific therapy. The spontaneous regression of a very large HCC is very rare and limited data is available in the English literature. We describe spontaneous regression of hepatocellular carcinoma in a 65-year-old male who presented to our clinic with vague abdominal pain and weight loss of two months duration. He was found to have multiple hepatic lesions with elevation of serum alpha-fetoprotein (AFP) level to 6,500 µg/L (normal <20 µg/L). Computed tomography revealed advanced HCC replacing almost 80% of the right hepatic lobe. Without any intervention the patient showed gradual improvement over a period of few months. Follow-up CT scan revealed disappearance of hepatic lesions with progressive decline of AFP levels to normal. Various mechanisms have been postulated to explain this rare phenomenon, but the exact mechanism remains a mystery.
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Affiliation(s)
- Adel Alqutub
- Liver Unit, London Health Sciences Centre, Ontario, Canada.
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Chua TC, Morris DL. Exploring the role of resection of extrahepatic metastases from hepatocellular carcinoma. Surg Oncol 2011; 21:95-101. [PMID: 21397495 DOI: 10.1016/j.suronc.2011.01.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/19/2010] [Accepted: 01/31/2011] [Indexed: 12/11/2022]
Abstract
The role of hepatic resection, taking into consideration the functional status of the liver, for localized hepatocellular carcinoma (HCC) is an established curative treatment. In advance disease, a variety of interventional-based liver-directed therapies and more recently systemic therapy with sorafenib are available to treat unresectable tumors. Extrahepatic Metastasis (EHM) of HCC may occur at initial diagnosis or during recurrence following treatment. This may occur with or without concurrent intrahepatic disease. We reviewed the published works on surgical metastasectomy for common sites of EHM of HCC metastases. It appears from the studies reported in the literature that from selected cases reported, long-term survival may be achieved from resecting metastasis at sites of the abdominal lymph node, adrenal gland, lung, and peritoneum. The encouraging results presented demonstrate that highly selected fit patients may be suitable candidates for these radical curative pursuits. It is likely that indications for resection of EHM HCC may benefit patients with limited isolated metastasis, who have a preserved liver function, and whose primary tumor has been adequately controlled. A registry study to pull the results of case reports and institutional experiences may be useful in cumulating evidence of this practice.
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Affiliation(s)
- Terence C Chua
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales (UNSW), Department of Surgery, Short Street, St George Hospital, Kogarah, NSW 2217, Sydney, Australia
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Ding JH, Chua TC, Al-Mohaimeed K, Morris DL. Hepatocellular Carcinoma Peritoneal Metastases: Report of Three Cases and Collective Review of the Literature. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n9p734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Patients with peritoneal metastases (PM) from hepatocellular carcinoma (HCC) often experience a rapid demise even after a complete removal of intrahepatic tumour. Localised PM may now be adequately controlled and managed with cytoreductive surgery (CRS). Treatment: Three patients underwent CRS for HCC PM. Outcome: The first patient survived 21 months from the time of CRS and is alive with the disease. The second patient died 4 months after CRS. The third patient survived 10 months since CRS and is also alive with the disease. Collectively, the survival of 24 patients with HCC PM extracted through a collective literature review who were treated with cytoreductive surgery had 1- and 2-year survival percentages of 83% and 71%, respectively. Conclusion: Careful selection of patients with localised disease to the peritoneal cavity for CRS, taking into consideration the performance status, liver function and tumour biology may lead to a successful outcome in patients with HCC PM.
Key words: Cytoreductive surgery, Peritoneal dissemination
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Affiliation(s)
- Jesslyn H Ding
- University of New South Wales, St George Hospital, Kogarah, NSW, Sydney, Australia
| | - Terence C Chua
- University of New South Wales, St George Hospital, Kogarah, NSW, Sydney, Australia
| | | | - David L Morris
- University of New South Wales, St George Hospital, Kogarah, NSW, Sydney, Australia
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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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12
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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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Iwaki K, Ohta M, Ishio T, Kai S, Iwashita Y, Shibata K, Himeno K, Seike M, Fujioka T, Kitano S. Metastasis of hepatocellular carcinoma to spleen and small intestine. ACTA ACUST UNITED AC 2008; 15:213-9. [PMID: 18392718 DOI: 10.1007/s00534-007-1230-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 03/23/2007] [Indexed: 12/18/2022]
Abstract
Metastasis of cancer to the spleen or small intestine is rare. We encountered a case of hepatocellular carcinoma (HCC) with splenic and jejunal metastases. A 60-year-old man was referred to us in February 2005 with a diagnosis of splenic tumor. Since 2001, he had been treated repeatedly for HCC with liver cirrhosis due to hepatitis C virus infection; partial liver resection, transcatheter arterial chemo-embolization, and radiofrequency ablation therapy had been performed. In October 2004, he had undergone partial pulmonary resection due to metastasis of HCC to the lung. The splenic tumor, which was detected by computed tomography, seemed to be a metastasis of HCC. Splenectomy was performed for the splenic tumor, and a jejunal tumor was discovered and also resected. Both the splenic and jejunal tumors were diagnosed pathologically as metastases from the HCC. After repeated treatment for HCC, metastases can appear in various organs; thus, careful observation is necessary during follow-up.
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Affiliation(s)
- Kentaro Iwaki
- First Department of Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita 879-5593, Japan
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Otsuka T, Hagiwara S, Tojima H, Yoshida H, Takahashi T, Nagasaka K, Tomioka S, Ando T, Takeuchi K, Kori T, Ohno Y, Kakizaki S, Takagi H, Mori M. Hepatocellular carcinoma with peritoneal dissemination which was regressed during vitamin K2 and vitamin E administration. Intern Med 2007; 46:711-5. [PMID: 17541221 DOI: 10.2169/internalmedicine.46.6131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 65-year-old man with positive anti-hepatitis C antibody and chronic renal failure was diagnosed as having a ruptured hepatocellular carcinoma (HCC) based on computed tomography (CT). The patient underwent transcatheter arterial embolization (TAE) for the HCC. After one more session of TAE, the patient underwent surgery. But HCC seeding peritoneally was pointed out. Vitamin K2 and vitamin E were administered as a conservative treatment. Six months after starting vitamins K2 and E, the primary tumor did not increase in size and intraperitoneal dissemination disappeared on CT with a significant decrease of alpha-fetoprotein. Even though this is only one case, combination therapy of vitamin K2 and E may induce growth suppression of HCC.
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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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