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Spontaneous Regression Of Multiple Pulmonary Recurrences Of Hepatocellular Carcinoma After Hepatectomy: Report Of A Case.

Harimoto, N. 2012Liver cancer

Harimoto, N., Shirabe, K., Kajiyama, K., Gion, T., Takenaka, M., Nagaie, T., & Maehara, Y. (2012). spontaneous regression of multiple pulmonary recurrences of hepatocellular carcinoma after hepatectomy: report of a case. Surgery today, 42(5), 475–478. https://doi.org/10.1007/s00595-011-0030-7

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Abstract

Spontaneous regression of hepatocellular carcinoma (HCC) is an extremely rare phenomenon. We herein report the case of a 73-year-old man who showed the spontaneous regression of multiple pulmonary recurrences of HCC that had occurred after hepatectomy. The patient was undergoing dialysis due to diabetic renal failure when ultrasonography revealed a liver tumor (diameter ~ 10 cm). A preoperative diagnosis of HCC with hepatic vein thrombosis was made. The liver function was well preserved and then the right hepatic vein area was resected. Two months after hepatectomy the α-fetoprotein level increased, and multiple lung nodules were observed on follow-up computed tomography. A diagnosis of multiple lung metastases was made, but no therapy was started because of the patient's renal failure. Five months after hepatectomy the α-fetoprotein level normalized, and the metastases regressed completely. The patient is now doing well without any recurrence at 13 months after the surgery. The associated literature on spontaneous HCC regression is also reviewed.

Case Details

Disease Location

Liver with lung mets

Personal Characteristics

73-year-old man, dialysis three times a week due to diabetic renal failure.

Clinical Characteristics

General fatigue. Us revealed a liver tumor of about 10 cm in diameter. Laboratory test showed elevated AFP and pivka ii, positive HCV. CT showed a peripherally enhanced low-density mass (diameter 9 cm) in segments 6 and 7. The tumor was accompanied by a tumor thrombus to the right hepatic vein. Extended posterior segmentectomy of the liver was performed. Histological findings revealed a poorly differentiated hcc with a trabecular pattern. Two months after hepatectomy, the serum levels of AFP and pivkaii increased, and multiple lung nodules were observed on follow-up CT. We diagnosed the patient with multiple lung metastases.

Remission Characteristics

Five months after hepatectomy, the multiple lung metastases had completely regressed and the AFP and pivkaii levels were both normalized

Treatment & Mechanisms

Proposed Remission Mechanisms

Extended posterior segmentectomy

Clinical Treatment

Hypotension during dialysis