Spontaneous Regression Of Recurrent Hepatocellular Carcinoma With Multiple Lung Metastases
Liu, Z., Zou, J. W., Wang, W. L., & Li, Z. (2020). Spontaneous regression of recurrent hepatocellular carcinoma with multiple lung metastases. Journal of cancer research and therapeutics, 16(7), 1710–1713. https://doi.org/10.4103/jcrt.JCRT_766_20
View Original Source →Abstract
Spontaneous regression (SR) of hepatocellular carcinoma (HCC) is a rare phenomenon but its true incidence is much higher than expected. We report a recurrent HCC who experienced SR both in intrahepatic lesion and lung metastasis. Serum alpha-fetoprotein decreased dramatically from more than 1000 μg/L to normal range. In addition, we reviewed 11 similar case reports published in recent 5 years. We find that the interval from diagnosis to the recognition of SR is very short (4 m, 1-14 m). Therefore, we speculate the mechanism of SR should be a severe systemic reaction, and immune activation is the most likely conjecture.
Case Details
Disease Location
Liver
Personal Characteristics
67‐year‐old male. History of type 2 diabetes mellitus treated with metformin, and hepatitis c infection without treatment.
Clinical Characteristics
Admitted for liver tumors identified on color doppler ultrasound during routine physical examination. AFP was elevated. CT revealed a 25 mm tumor in segment 3 and a 44 mm tumor in segment 6. Hepatectomy was performed. Histopathological diagnosis was moderately differentiated hcc. One month after surgery, contrast‐enhanced abdominal CT revealed multiple abnormally small enhancement lesions in the liver that were highly suggestive of recurrence. Transcatheter arterial chemoembolization (tace) was then performed. 40 mg pirarubicin,100 mg oxaliplatin, and 1000 mg fluorourea were infused slowly through a microcatheter in the proper hepatic artery. Embolization of the lesions using 4 ml iodized oil was then performed. Repeated tace procedures were performed at 4, 7, and 10 months after surgery. 14 months after surgery developed bloody sputum during routine follow‐up. Chest CT showed multiple metastases in both lungs. Abdominal enhanced mr imaging (MRI) showed multiple small lesions in the liver. Serum AFP rose to more than 1000 μg/l. He took chinese herbal medicine (bruce javanica capsule) irregularly
Remission Characteristics
19 months after surgery chest CT showed that the lung metastasis disappeared completely. No hepatic masses were detected on the abdominal enhanced CT.
Treatment & Mechanisms
Proposed Remission Mechanisms
Immune activation is the most likely conjecture.
Clinical Treatment
Hepatectomy, tace, chemotherapy
Non-Clinical Treatment
Bruce javanica capsule