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Spontaneous Regression Of Hepatocellular Carcinoma: What Three Cases Of Regression And Disease Reoccurrence Can Tell Us

Ghattu, M. 2022Liver cancer

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

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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

65-year-old male. History of cirrhosis due to chronic HCV infection

Clinical Characteristics

Presented with encephalopathy and lethargy for several weeks. An ultrasound of the abdomen showed multiple bi-lobar liver lesions, including a large multilobulated right hepatic lobe lesion in a subcapsular location, suspected to represent multifocal hcc. At the time AFP was elevated. The large multilobulated right hepatic lobe lesion was li-rads 5. He was referred to hospice.

Remission Characteristics

Over the course of 15 months in hospice, the patient made significant functional gains. This unexpected recovery prompted an AFP recheck, which revealed a significant reduction. A CT scan showed a reduction in infiltrative disease with near complete resolution of the massive infiltrative right hepatic lobe mass

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.