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Spontaneous Regression of Hepatocellular Carcinoma and Review of Reports in the Published English Literature. Case Rep Med 2019; 2019:9756758. [PMID: 31049068 PMCID: PMC6462316 DOI: 10.1155/2019/9756758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/21/2019] [Indexed: 12/12/2022] Open
Abstract
Background Spontaneous regression of hepatocellular carcinoma (HCC) is a rare event, although it has been described by numerous groups. The long-term fate of individuals experiencing an SR is not well described, and the underlying mechanism(s) of SR are unknown. Case Presentation: A 79-year-old Asian female with metastatic HCC taking only valsartan for hypertension had a marked reduction in tumor dimension in the primary tumor and the pulmonary metastases. Serum alpha-fetoprotein (AFP) decreased from 17,833 μg/L to 26 μg/L. Her disease progressed after 71 months, and she died shortly after. In a review of 66 patients with SR reported in the English literature, median survival was 83 months. Median survival in 37 cases that underwent resection after SR was 108 months. Conclusions The case and a review of the literature illustrate that SR is often durable and associated with an excellent prognosis. Understanding the underlying mechanism of SR may point to novel therapeutic strategies.
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Frenkel M, Gross S, Popper Giveon A, Sapire K, Hermoni D. Living outliers: experiences, insights and narratives of exceptional survivors of incurable cancer. Future Oncol 2016; 11:1741-9. [PMID: 26075442 DOI: 10.2217/fon.15.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIM Unexplained prolonged survival given a diagnosis of incurable advanced cancer is a puzzling phenomenon that recently has attracted more scientific research. The purpose of this study was to add to the understanding of how exceptional patients perceive and explain their unusual experience. METHODS We recruited patients for interviews from a population registry, patients with advanced lung or pancreatic malignancy who experienced exceptional survival. RESULTS & CONCLUSION In total, 15 participants were interviewed. The main recurrent themes in most of the interviews were patient-doctor communication, family support and the patient's proactive attitude. In this study, patients attribute their longevity to relationships with their doctor and their family - not the type of treatment they received. Further research on this phenomenon is needed.
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Affiliation(s)
- Moshe Frenkel
- Department of Family Medicine, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.,The Integrative Medicine Unit, The Institute of Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Sky Gross
- The Minerva Center for End-of-Life Studies, Tel Aviv University, Tel Aviv, Israel
| | | | - Kenneth Sapire
- Department of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Doron Hermoni
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University & Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
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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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Bhardwaj N, Li M, Price T, Maddern GJ. Spontaneous regression of a biopsy confirmed hepatocellular carcinoma. BMJ Case Rep 2014; 2014:bcr2014204897. [PMID: 25053671 PMCID: PMC4112320 DOI: 10.1136/bcr-2014-204897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/30/2023] Open
Abstract
A 74-year-old woman was diagnosed with histologically proven multiple bilobar hepatocellular carcinomas (HCC) in 2012. The lesions were inoperable and a repeat CT scan prior to starting chemotherapy revealed spontaneous regression of these lesions. Subsequent repeat scans have revealed continued regression of these lesions despite no active treatment. The case is presented with a literature review and discussion summarising the possible aetiologies of this phenomenon.
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Affiliation(s)
| | - Mo Li
- The Queen Elizabeth Hospital, Adelaide, Australia
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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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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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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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Giannetti A, Corsetti M, Quaranta S, Franci L. Contrast-enhanced sonography of a hepatocellular carcinoma undergoing spontaneous necrosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:492-496. [PMID: 18663752 DOI: 10.1002/jcu.20518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Spontaneous necrosis of hepatocellular carcinoma (HCC) is rare. We report the case of a 72-year-old woman with an HCC nodule that underwent necrosis after sonographically guided needle biopsy. Baseline sonographic examination revealed only a nonspecific change in the echogenicity of the lesion. Subsequent necrosis was suggested on contrast-enhanced sonographic examination and was confirmed on spiral CT.
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Affiliation(s)
- Andrea Giannetti
- Department of Gastroenterology, Misericordia Hospital, Via Senese 22, 58100 Grosseto, Italy
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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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D'Ippolito G, Abreu Junior LD, Borri ML, Galvão Filho MDM, Hartmann LGC, Wolosker AMB, Ribeiro M, Salem MZ, Misiara A. Apresentações incomuns do hepatocarcinoma: ensaio iconográfico. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000200013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste trabalho foi descrever e ilustrar aspectos incomuns do hepatocarcinoma na tomografia computadorizada e ressonância magnética. A partir da análise retrospectiva de 100 casos de pacientes com hepatocarcinoma diagnosticado por análise combinada de exames de imagem, dosagem de alfa-feto-proteína, biópsia percutânea ou ressecção cirúrgica, selecionamos aqueles com apresentação atípica em um ou mais métodos de imagem ou aqueles com evolução não usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hepatocarcinomas císticos, hemorrágicos, rotos e causando hemoperitônio, calcificados, com regressão espontânea, exofíticos, hipovasculares, gigantes e com disseminação não usual. O hepatocarcinoma é o tumor maligno mais comum do fígado e freqüentemente tem apresentação típica e associada à cirrose hepática. Porém, em alguns casos, apresentações atípicas podem retardar o seu diagnóstico.
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