Pathological Evidence Of The Cause Of Spontaneous Regression In A Case Of Resected Hepatocellular Carcinoma.
Matsuoka, S., Tamura, A., Moriyama, M., Fujikawa, H., Mimatsu, K., Oida, T., & Sugitani, M. (2015). Pathological evidence of the cause of spontaneous regression in a case of resected hepatocellular carcinoma. Internal medicine (Tokyo, Japan), 54(1), 25–30. https://doi.org/10.2169/internalmedicine.54.2981
View Original Source →Abstract
A 67-year-old man presented for an evaluation after experiencing right hypochondrial pain lasting for two months. Abdominal ultrasonography showed a hepatic tumor in the right liver and extremely mild hepatic steatosis. The imaging findings indicated that the tumor (43 mm in size) was ischemic, and the lesion was surgically resected and examined. The histopathological findings demonstrated 95% necrosis with moderately differentiated hepatocellular carcinoma (HCC). The diagnosis was HCC with spontaneous regression. There was also pathological evidence of thrombus formation in the peripheral arteries and portal veins. In addition, the non-cancerous regions of the liver were diagnosed as exhibiting non-alcoholic steatohepatitis. The pathological findings obtained after resection of the HCC lesion showed spontaneous regression.
Case Details
Disease Location
Liver
Personal Characteristics
67-year-old man, obese, the patient had begun a diet three years earlier and had succeeded in reducing his weight by approximately 5 kg. Past medical history of hypertension at 48 years of age and diabetes mellitus and hepatic dysfunction due to hepatic steatosis at 55 years of age, with no history of transfusion. He had no history of alcohol consumption or smoking and no family history of note.
Clinical Characteristics
Patient presented with two months of hypocondrial pain. On the first examination, only mild hepatic dysfunction and hypercholesterolemia were observed. How- ever, since abdominal ultrasonography showed an approxi- mately 42-mm neoplastic lesion in segment s6 of the right lobe of the liver, the patient was hospitalized for further examinations and treatment. Contrast-enhanced ultra- sonography, contrast-enhanced abdominal computed to- mography (CT) showed no dense staining on arterial phase images. In addition, the abdominal angiography findings showed no dense staining in the cancerous portions of the liver on early vascular phase images. Based on these imaging and hematological findings, the possibility of atypical hcc, intrahepatic bile duct carcinoma or hodg- kin’s disease was considered. However, no definitive diagnosis was made, and segment 6 subsegmental resection was subsequently performed on day 18 of hospitalization. The pathological diagnosis was moderately differentiated hcc
Remission Characteristics
The patient’s postoperative course was favorable, and he was discharged from the hospital 11 days after undergoing surgery. He has since visited the hospital regularly for over three years, with no signs of recurrence.
Treatment & Mechanisms
Proposed Remission Mechanisms
Spontaneous regression due to the presence of both arterial and portal vein thrombi.
Clinical Treatment
Mass resection