Spontaneous Regression Of Hepatocellular Carcinoma Confirmed By Surgical Specimen: Report Of Two Cases And Review Of The Literature.

Stoelben, E. 1998Liver cancer

Stoelben, E., Koch, M., Hanke, S., Lossnitzer, A., Gaerightner, H. J., Schentke, K. U., Bunk, A., & Saeger, H. D. (1998). spontaneous regression of hepatocellular carcinoma confirmed by surgical specimen: report of two cases and review of the literature. Langenbeck's archives of surgery, 383(6), 447–452. https://doi.org/10.1007/s004230050158

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Abstract

Two cases with spontaneous regression of a histologically confirmed hepatocellular carcinoma (HCC) are presented. This rarely seen phenomenon of a spontaneous tumor involution is discussed and compared with the current literature. The clinical symptoms were very similar to that of a liver abscess. A 56-year-old male suffered from a multicentric, highly differentiated, trabecular HCC. First symptoms were epigastric pain, septic fever and arthritis. The tumor marker AFP was constantly normal and no hepatitis could be verified. A resection of the tumor was performed. In patient 2, a 74-year-old male, a multicentric, clear cell HCC was found. The patient had completely recovered from hepatitis type B and within the liver tissue no viruses could be identified. Clinical symptoms were mainly characterized by upper abdominal pain and septic fever. AFP was excessively elevated (3850 ng/ml) but returned to normal preoperatively. In both cases, the specimen showed a subtotal necrotic HCC with insignificant amounts of vital tumor cells. Neither patient had a liver cirrhosis macroscopically, however patient 2 had local periportal fibrosis histologically. After 24 and 41 months of follow-up, respectively, both patients are in good health

Case Details

Disease Location

Liver

Personal Characteristics

56-year-old male, psoriasis, gout, diabetes mellitus type ii b, essential hypertension, reflux esophagitis ii0 with a hiatal hernia, and a state after traumatic fracture of the right ribs 6 to 9 in 1989

Clinical Characteristics

He reported common discomfort and fatigue for approximately 2 months, and for 2 weeks, pain in the right costal arch, dry cough, fever up to 40.0 c, watery- slimy diarrhea, as well as swelling and pain of the right knee and of both ankle joints. The weight loss totaled 8 kg within the last 5 months. Ca 19-9 and ca 125 were elevated. Ultrasound investigation found an inhomogeneous focus of 6×5 cm in size inside liver s6. A liver abscess with regenerative proliferating liver epithelium without signs of malignancy was suspected. The patient was admitted to our hospital 2 months after onset of symptoms. The liver was palpable approx. 2 cm below the costal arch and without pain on palpation. Another puncture of the focus was performed. At this time the tumor was 4 cm in diameter. Histologically, the tumor was compatible with primary hcc. On subsequent liver surgery, the redescribed focus was removed by anatomical resection of segment vi

Remission Characteristics

Another puncture of the focus was performed. At this time the tumor was 4 cm in diameter. Histologic assessment of the specimens from both tumors showed a mainly necrotic, multivocal, highly differentiated, trabecular-like hcc with a connective tissue-like pseudocapsule