Two Cases Of Spontaneous Regression Of Multicentric Hepatocellular Carcinoma After Intraperitoneal Rupture: Possible Role Of Immune Mechanisms.
Blondon, H., Fritsch, L., & Cherqui, D. (2004). Two cases of spontaneous regression of multicentric hepatocellular carcinoma after intraperitoneal rupture: possible role of immune mechanisms. European journal of gastroenterology & hepatology, 16(12), 1355–1359. https://doi.org/10.1097/00042737-200412000-00020
View Original Source →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.
Case Details
Disease Location
Liver
Personal Characteristics
Case 1: 64-year-old man. Past history of heavy drinking.
Clinical Characteristics
Admitted to the hospital for acute pain in the right hypochondrium. One year earlier evidence of a 20mm tumour in the right lobe of the liver had been obtained. The patient refused further investigation. At admission, physical examination revealed neither liver enlargement nor jaundice but scrotal haematoma. Laboratory tests were within normal range. Hepatitis viruses were negative. AFP was elevated. Abdominal CT showed multiple low-density hypoenhacned liver tumours involving all segments. No portal vein thrombosis. Multicentric hcc and alcohol related liver cirrhosis were diagnosed. Three months later, CT scan and MRI showed only one persisting tumour, 30 mm in diameter, in the inferior posterior segment of the right lobe.
Remission Characteristics
Three months later, clinical condition improved and AFP returned to normal values. CT showed regression of all liver tumours, with a centimetric cyst appearance of all except one. Histological study of the specimen (obtained from surgery) confirmed a well-differentiated encapsulated hcc with the presence of marked inflammation, necrosis with calcifications, and fibrosis.
Treatment & Mechanisms
Proposed Remission Mechanisms
Immune activation inducing specific anti-tumoural reaction by t-cell cytotoxicity.
Clinical Treatment
Acetaminophen and propoxyphene. Segmentectomy of the posterior inferior s6