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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

57-year-old female. History of cirrhosis due to HCV infection and prior hcc in remission, treated with surgical wedge resection three years prior to presentation

Clinical Characteristics

Presented due to an increase in AFP. Ultrasound showed a new 1.7 cm mass of the left hepatic lobe concerning for hcc. MRI of the abdomen and pelvis confirmed a li-rads 5 subcapsular lesion with 2 surrounding li- rads 3 and li-rads 2 lesions, which was diagnostic for hcc

Remission Characteristics

Repeat imaging prior to a planned hepatic angiogram showed spontaneous regression of the 2 cm li-rads 5 lesion. AFP had also decreased from 27.2 ng/ml to 5.5 ng/ml.

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.