The Mysterious Case Of Spontaneous Disappearance Of Hepatocellular Carcinoma.

Del & Oggio, 2009Liver cancer

Del Poggio, P., Mattiello, M., Gilardoni, L., Jamoletti, C., Colombo, S., & Zabbialini, G. (2009). The mysterious case of spontaneous disappearance of hepatocellular carcinoma. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 41(7), e21–e25. https://doi.org/10.1016/j.dld.2008.02.001

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Abstract

We describe the case of a 77-year-old woman with chronic hepatitis C and well compensated cirrhosis in whom a single encapsulated 5.5 cm hepatocellular carcinoma was found in the right liver lobe. The patient was symptomatic with left upper quadrant pain and had elevated alfa-fetoprotein levels (3133 ng/ml). While she was waiting for liver resection and 2 months after the initial diagnosis the pain improved and alfa-fetoprotein levels normalized. A computerized tomography scan showed reduction in size of the lesion to 2.5 cm, with no central arterial enhancement, but with the demonstration of a peripheral rim enhancing in all dynamic phases. Follow up computerized tomography and magnetic resonance imaging examinations showed further reduction in size of the lesion to 1.3 cm with persistence of the enhancing rim 20 months after the initial diagnosis. The spontaneous and durable regression of the HCC and the persistent peripheral enhancing rim could be explained by a strong and persistent activation of the immune system directed against the neoplastic cells.

Case Details

Disease Location

Liver

Personal Characteristics

77-year-old woman, hepatitis c was diagnosed at the age of 69, cholecystectomy for gallstones at the age of 30, partial thyroidectomy for multinodular goiter at the age of 35 and hysterectomy for uterine le-year-old maleioma at the age of 47

Clinical Characteristics

Persisting dull pain in the right hypochondrium, not alleviated by common pain killers. An abdominal ultrasound performed 18 months earlier showed a coarse echo pattern with surface nodularity, but no focal lesions. Pe: the liver edge was felt at 2 cm below the costal margin with an increased consistency. Laboratory tests showed elevated ast and alt at the upper normal range, significant elevation of AFP. At ultrasound a single 5.5cm mixed hypo-hyperechoic encapsulated focal lesion was found at segment 6 of the liver. This finding, in conjunction with the elevated alfa-fetoprotein levels and in the context of a cirrhotic liver, was considered typical of hcc

Remission Characteristics

She was waiting for a partial right liver resection and 3 months after the onset of symptoms, the pain gradually abated and the analgesics could be discontinued. A control CT scan showed a reduction in size of the focal liver lesion to 2.8 cm. Laboratory tests showed normalization of AFP levels. Another CT scan demonstrated a further reduction in size of the focal lesion whose diameter was now 1.8 cm.