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Spontaneous Regression Of Hepatocellular Carcinoma: Two Case Reports And A Literature Review.

Kato, H. 2004Liver cancer

Kato, H., Nakamura, M., Muramatsu, M., Orito, E., Ueda, R., & Mizokami, M. (2004). spontaneous regression of hepatocellular carcinoma: two case reports and a literature review. Hepatology research : the official journal of the Japan Society of Hepatology, 29(3), 180–190. https://doi.org/10.1016/j.hepres.2004.03.005

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Abstract

Spontaneous regression of a malignant tumor is extremely rare. Here we report two cases of spontaneous regression of hepatocellular carcinoma (HCC), and review the associated literature. Case 1 was a 77-year-old male with HCC in the right lobe and multiple lung metastases. alpha-fetoprotein (AFP) and protein induced by vitamin K deficiency or antagonist II (PIVKA-II) were >50,000ng/ml and 21,500mAU/ml, respectively. He and his family refused further treatment, and he was discharged. Four months after the diagnosis, dramatic diminution of HCC and lung metastases was noted, and the HCC had disappeared completely 12 months later. Case 2 was a 72-year-old male with multiple nodular regions with enhanced circumference in the right lobe, the largest of which was 8cm in diameter, referred to the gastroenterology unit of our hospital. Laboratory analyses showed positive for hepatitis C virus antibody, and AFP and PIVKA-II were 936.3ng/ml and 2,380mAU/ml, respectively. However, he and his family refused further treatment, and he was followed-up as an outpatient by a local clinic. Two years later, radiological investigations revealed remarkable regression of HCC. Laboratory analyses showed that PIVKA-II had decreased to the normal range, while AFP had increased to double the original value.

Case Details

Disease Location

Liver + lungs mets

Personal Characteristics

77-year-old male, type 2 diabetes mellitus, he had smoked 20 cigarettes per day since adolescence

Clinical Characteristics

Severe fatigue and thirst, the liver was slightly enlarged and palpable 2 cm below the right costal margin. Blood sugar was high, AFP and pivka-ii were elevated. Abdominal us and contrast-enhanced CT revealed a well-circumscribed space-occupying lesion 7 cm in diameter in the right lobe of the liver. Chest x-ray and CT showed multiple nodular shadows bilaterally in the lung. He was diagnosed as hcc with multiple lung metastase

Remission Characteristics

Four months after the diagnosis, radiological studies revealed a wedge-shaped low-density area (indicating necrosis of hcc) in the liver and the disappearance of multiple nodular lesions in both lungs. Tumor markers returned to normal values

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Glibenclamide, voglibose, and epalrestat orally, short-acting insulin