Recurrence Of Hepatocellular Carcinoma With Epithelial-mesenchymal Transition After Spontaneous Regression: A Case Report.
Yang, S. Z., Zhang, W., Yuan, W. S., & Dong, J. H. (2015). Recurrence of Hepatocellular Carcinoma With Epithelial-Mesenchymal Transition After spontaneous Regression: A Case report. Medicine, 94(28), e1062. https://doi.org/10.1097/MD.0000000000001062
View Original Source →Abstract
Hepatocellular carcinoma (HCC) is one of the most malignant cancers and ranks as the third leading cause of cancer-related death in the world. However, some patients with untreated HCC can experience spontaneous regression, a rare phenomenon that has been observed in various malignancies. Here, we report a unique case with untreated HCC, who first underwent a spontaneous cancer regression after the spontaneous clearing of chronic hepatitis B virus (HBV) infection from the liver as evidenced by hepatitis B virus surface antigen (HBsAg) seroconversion; then developed the recurrent HCC with epithelial-mesenchymal transition (EMT) after 14 years. We hypothesized that a strengthened immune system in response to HBV infection may have led to immune-mediated spontaneous cancer regression. The later recurrence of HCC may suggest the host's immune system was no longer able to contain HCC since aging and other chronic diseases may have significantly weakened the immune surveillance.
Case Details
Disease Location
Liver
Personal Characteristics
56-year-old man, 15-year history of chronic liver disease related to HBV
Clinical Characteristics
Presented with right abdominal discomfort, positive af. Abdominal us detected a solid mass measuring 2x2cm in the right liver. A contrast-enhanced CT scan confirmed a low-density mass in s6. An early-stage hcc diagnosis was made. Patient refused treatment. Three years later he was readmitted to the hospital for right abdominal pain. A new abdominal contrast-enhanced CT scan revealed multiple hepatic masses suggestive of hcc with multiple intrahepatic metastases. Again, he refused treatment and was discharged. One months later, abdominal us showed no masses. 14 years later represented with increasing abdominal distension and pain, tumour markers were high, contrast-enhanced CT showed 2 huge (7x5 and 10x6 cm), and heterogeneous masses in segments 7 and 6 of the liver. Ultrasonography-guided biopsies revealed 2 different tumour cell populations. The tumour tissue in s7 consisted of poorly differentiated cancerous parenchymal hepatocytes, the tumour in s6 was composed of spindle-shaped cells. He refused treatment, he died later.
Remission Characteristics
One months after the second hospital discharge, no masses were found on abdominal us
Treatment & Mechanisms
Proposed Remission Mechanisms
Both the spontaneous hbsag seroconversion and the hcc regression could be trig- gered by restoration or reinforcement of virus-specific t-cell immunity