Spontaneous Regression Of Hepatocellular Carcinoma: What Three Cases Of Regression And Disease Reoccurrence Can Tell Us
Ghattu, M., Engstrom, B. I., & Hanouneh, I. A. (2022). Spontaneous regression of hepatocellular carcinoma: what three cases of regression and disease reoccurrence can tell US. Radiology case reports, 17(9), 3405–3409. https://doi.org/10.1016/j.radcr.2022.06.086
View Original Source →Abstract
Hepatocellular carcinoma (HCC) is a highly morbid disease both in the United States and worldwide. Chronic liver inflammation puts people at risk of developing HCC. As chronic liver disease prevalence increases in the United States there can be an expected rise in HCC. Spontaneous regression of HCC is a rare phenomenon but can provide much needed information on how to better understand disease characteristics and progression. The two proposed theories that may explain spontaneous regression are tumor hypoxia and immunologic reaction. In these cases, we describe 3 patients with heavy disease burden at presentation who showed spontaneous regression of cancer. The patient's characteristics correlate most with systemic immunologic reaction resulting in spontaneous regression. Unfortunately, all of these patients had disease recurrence shortly after regression. By studying patient data in cases of spontaneous regression, we can gain a better understanding of disease progression and which exogenous or endogenous factors determine HCC mortality. With this knowledge we hope to better characterize how spontaneous regression occurs, and how we can use this information to help in developing treatment options in the future.
Case Details
Disease Location
Liver
Personal Characteristics
64-year-old male
Clinical Characteristics
Presented with sepsis secondary to necrotizing pneumonia, and was incidentally found to have multiple low-attenuated masses in the right lobe of the liver on a computed tomography (CT) scan. Alpha fetoprotein (AFP) at the time was elevated. Biopsy findings were consistent with hepatocellular carcinoma (hcc). There was concern for lung metastasis, and the patient was advised to undergo a lung biopsy. Prior to lung biopsy, the patient suffered a stroke, thus halting further workup.
Remission Characteristics
Several months later, when the patient followed up for his hcc, there was near complete spontaneous regression of the liver masses and lung nodules.
Treatment & Mechanisms
Proposed Remission Mechanisms
The more peripheral location could predispose the tumor to ischemia, given the more tenuous blood supply, particularly in cirrhotic livers and subcapsular masses. Furthermore, the subcapsular location and potentially local disruption of the capsule may predispose a lesion for immunologic presentation.
Clinical Treatment
Biopsy