Spontaneous Regression Of A Large Hepatocellular Carcinoma: Case Report.
Alqutub, A., Peck, D., & Marotta, P. (2011). spontaneous regression of a large hepatocellular carcinoma: case report. German medical science : GMS e-journal, 9, Doc07. https://doi.org/10.3205/000130
View Original Source →Abstract
The prognosis of untreated advanced hepatocellular carcinoma (HCC) is grim with a median survival of less than 6 months. Spontaneous regression of HCC has been defined as the disappearance of the hepatic lesions in the absence of any specific therapy. The spontaneous regression of a very large HCC is very rare and limited data is available in the English literature. We describe spontaneous regression of hepatocellular carcinoma in a 65-year-old male who presented to our clinic with vague abdominal pain and weight loss of two months duration. He was found to have multiple hepatic lesions with elevation of serum alpha-fetoprotein (AFP) level to 6,500 µg/L (normal <20 µg/L). Computed tomography revealed advanced HCC replacing almost 80% of the right hepatic lobe. Without any intervention the patient showed gradual improvement over a period of few months. Follow-up CT scan revealed disappearance of hepatic lesions with progressive decline of AFP levels to normal. Various mechanisms have been postulated to explain this rare phenomenon, but the exact mechanism remains a mystery.
Case Details
Disease Location
Right hepatic lobe
Personal Characteristics
65-year old male; 1-week history of abdominal pain; anorexia and 12-lb weight loss over two months prior; history of hypertension, diabetes, hypercholesterolemia and obesity; blood pressure 120/60
Clinical Characteristics
Elevated liver enzymes with alanine aminotransferase and aspartate aminotransferase 2x above normal; serum alphafetoprotein was 6500 ug/l and showed steady decline on follow-ups, remaining below 8 ug/l 6 months after initial examination; CT scan showed large heterogeneous dense mass involving right hepatic lobe; one small lesion seen in medial segment of left hepatic lobe; occlusive thrombus in right portal vein extending into main portal vein noted; scan also showed number of enlarged paraortic lympatienth nodes
Remission Characteristics
Over period of a few months, symptoms improved and tumour showed radiological evidence of spontaneous involution coupled with decrees in AFP levels, meeting criteria for spontaneous resolution; follow-up CT 14 weeks after initial diagnosis showed significant interval reduction in size of mass with associated atrophy of right hepatic lobe; occlusion of right portal veing at 14 weeks was still present, but main portal vein thrombus and periaortic lymphadenopathy had resolved; CT scan 28 weeks after initial diagnosis showed persistent right portal vein occlusion and small hypodensity in posterior segment of right hepatic lobe; CT scan 14 months from initial diagnosis showed small irregular hypodensity in posterior segment of right hepatic lobe with no area of abnormality anywhere else; ultrasound 2 years after initial diagnosis showed no liver lesions and AFP level remained below 10 ug/l
Treatment & Mechanisms
Proposed Remission Mechanisms
Speculation that local ischemia due to rapid tumour growth resulted in intra tumoural bleeding and/or hemorrhagic necrosis (based on cases in literature)